Cardiopulmonary Testing for Potential Pancreas transplant Candidates
Research type
Research Study
Full title
Measurement of Cardiopulmonary Exercise Functional Capacity in Patients with Type 1 Diabetes Mellitus approaching Simultaneous Kidney Pancreas Transplantation.
IRAS ID
198584
Contact name
Edward Sharples
Contact email
Sponsor organisation
Oxford University Hospitals Foundation NHS Trust
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Summary of Research
Type 1 diabetes is a major cause of kidney failure and premature death. Simultaneous kidney pancreas transplantation offers improved outcomes and normal blood sugars without insulin treatment. This involves a major operation and the risk of heart attacks and death in these already sick patients is high. At the moment, everyone being considered for the transplant waiting list has a scan to assess the blood supply to the heart, and a significant proportion need to have further investigation or intervention. Cardiopulmonary exercise testing has been used in pre-operative assessment for some types of major surgery, including liver transplantation. It measures the exercise capacity and gives a measure of heart and lung response to stress, and is less invasive than some other tests. It has not be used to assess patients with diabetes and kidney disease so it is unclear whether the current parameters of fitness are appropriate. We intend to perform CPET testing in a cohort of patients undergoing assessment to determine whether the additional information obtained can improve risk analysis or lead to intervention to reduce peri-operative complications.
Summary of Results
This study tested the feasibility of using cardiopulmonary exercise testing in the assessment of patients with type 1 diabetes going onto the waiting list for a kidney pancreas transplant. All participants had normal standard cardiac assessment by myocardial perfusion scan. Average age was 40.7 years, and all participants were on dialysis.
Exercise tolerance was reduced in all participants, with average anaerobic threshold 7.83, lower than that used as cut-off for non-cardiac surgery. Power threshold was lower than expected, and Vo2 max, as a measure of exercise intolerance, was average 44% expected.
This study shows that patients with type 1 diabetes and end-stage kidney disease have significant reduced power and exercise tolerance, compared to normal controls (literature) and therefore pre-habilitation should be considered to improve functional status on the transplant waiting list.REC name
West of Scotland REC 1
REC reference
18/WS/0015
Date of REC Opinion
30 Jan 2018
REC opinion
Further Information Favourable Opinion