Select
ID
Percent Missing
Name
Description
E.10.1 100.00% M6_FUP_CENTRE Recipient Details - Follow-up Centre E.10.2 100.00% M6_FUP_TRANSFER Transfer and non-attendance - The patient has transferred to another unit for follow-up E.10.3 100.00% M6_FUP_NOT_ATTEND Transfer and non-attendance - The patient has not attended for this follow-up but is expected to attend for future follow-up. Complete section 7 and return this form E.10.4 100.00% M6_FUP_LOST_TO_FUP Transfer and non-attendance - The patient is considered lost to follow-up. Further contact with the patient is not expected E.10.5 100.00% M6_FUP_COMMENT Transfer and non-attendance - Follow-up details - Further details E.10.6 100.00% M6_FUP_LAST_CONTACT Transfer and non-attendance - Follow-up details - Date of last contact with the patient (If exact date cannot be established a partial date, for example month and year will be accepted) E.10.7 100.00% M6_FUP_INITIAL_GRAFT_FUNC Post-operative course to 6 months (or graft failure if earlier than 6 months) - Initial graft function E.10.8 100.00% M6_FUP_DAYS_VENTILATE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Days ventilated E.10.9 100.00% M6_FUP_DAYS_ITU Post-operative course to 6 months (or graft failure if earlier than 6 months) - Days in ITU E.10.10 100.00% M6_FUP_PATIENT_DISCHARGE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Has recipient been discharged from hospital? E.10.11 100.00% M6_FUP_DISCHARGE_DATE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Date of initial discharge E.10.12 100.00% M6_FUP_HYPOGLYCAEMIA_EVENT Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Number of severe hypoglycaemia events E.10.13 N/A M6_FUP_EVENT_DATE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - If one or more, date of first event E.10.14 100.00% M6_FUP_ADDMISSION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Number of admissions with diabetic ketoacidosis E.10.15 N/A M6_FUP_ADDMISSION_DATE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - If one or more, date of first admission E.10.16 100.00% M6_FUP_ANGINA Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Angina E.10.17 100.00% M6_FUP_MYOCARDIAL_INFARCTION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Myocardial infarction E.10.18 100.00% M6_FUP_PCI Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - PCI E.10.19 100.00% M6_FUP_CORONARY_ARTERY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Coronary artery bypass graft E.10.20 100.00% M6_FUP_TRANSIENT_ATTACK Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Transient ischemic attack E.10.21 100.00% M6_FUP_CVA Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - CVA E.10.22 100.00% M6_FUP_INTER_CLAUDICTION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Intermittent claudication E.10.23 100.00% M6_FUP_PVD_INTERVENTION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - PVD intervention E.10.24 100.00% M6_FUP_FOOT_ULCERATION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Foot ulceration E.10.25 100.00% M6_FUP_LIMB_AMPUTATION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic complications (Please indicate complications that have occurred in the first 6 months post-transplant) - Limb amputation E.10.26 100.00% M6_FUP_DIABETIC_DDPHOTO Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic eye disease - Diabetic retinopathy confirmed by dilated digital photography E.10.27 100.00% M6_FUP_REGISTERED_BLIND Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic eye disease - Registered blind E.10.28 100.00% M6_FUP_LASER_PHOTO Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic eye disease - Laser photocoagulation E.10.29 100.00% M6_FUP_CATARACT Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic eye disease - Cataract E.10.30 100.00% M6_FUP_VITREOUS_HAEM Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic eye disease - Vitreous haemorrhage E.10.31 100.00% M6_FUP_VITRECTOMY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Diabetic eye disease - Vitrectomy E.10.32 100.00% M6_FUP_PROTEINURIA Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Proteinuria E.10.33 100.00% M6_FUP_ULCERATION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Ulceration E.10.34 100.00% M6_FUP_POSTURAL_HYPOTENSION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Postural hypotension E.10.35 100.00% M6_FUP_ERECTILE_SEXUAL_DYSF Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Erectile/sexual dysfunction E.10.36 100.00% M6_FUP_PREIPHERAL_NEUROPATHY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Peripheral neuropathy E.10.37 100.00% M6_FUP_GASTROPARESIS Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Gastroparesis E.10.38 100.00% M6_FUP_AUTONOMIC_SWEATING Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Autonomic sweating E.10.39 100.00% M6_FUP_CHARCOT_FOOT Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Charcot foot E.10.40 100.00% M6_FUP_NEURO_PAIN_SCORE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Neuropathic pain score (0-10, 0 = no pain) E.10.41 100.00% M6_FUP_DIABETIC_ENTEROPATHY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Diabetic enteropathy E.10.42 100.00% M6_FUP_AUTO_BLADDER_DYSF Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Autonomic bladder dysfunction E.10.43 100.00% M6_FUP_CHEIROARTHROPATHY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Cheiroarthropathy E.10.44 100.00% M6_FUP_MONONEUROPATHY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Nephropathy / neuropathy / musculoskeletal (record current status) - Mononeuropathy E.10.45 100.00% M6_FUP_THROID_DISEASE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other autoimmune disease - Thyroid disease E.10.46 100.00% M6_FUP_ADDISION_DISEASE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other autoimmune disease - Addison's disease E.10.47 100.00% M6_FUP_COELIAC_DISEASE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other autoimmune disease - Coeliac disease E.10.48 100.00% M6_FUP_RE_ADMISSION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Has the recipient required readmission due to complications? E.10.49 100.00% M6_FUP_PV_HEPATIC Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Portal vein / hepatic haemorrhage E.10.50 100.00% M6_FUP_PV_THROMBOSIS Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Portal vein thrombosis E.10.51 100.00% M6_FUP_PERF_GALL_BLADDER Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Perforated gall bladder E.10.52 100.00% M6_FUP_CMV_INFECTION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - CMV infection E.10.53 100.00% M6_FUP_VIRAL_INFECTION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Viral systemic infection E.10.54 100.00% M6_FUP_OTHER_COMPLICATION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Other E.10.55 100.00% M6_FUP_UTI Post-operative course to 6 months (or graft failure if earlier than 6 months) Other complications - Urinary tract infection (UTI) - Other E.10.56 100.00% M6_FUP_BACTERIAL_INFECTION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Bacterial systemic infection E.10.57 100.00% M6_FUP_INTRA_ABSCESS Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Intraperitoneal abscess E.10.58 100.00% M6_FUP_FUNGAL_INFECTION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Fungal systemic infection E.10.59 100.00% M6_FUP_LAPAROTOMIES_PERFORM Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Number of laparotomies performed since transplant? (No laparotomies = 0) E.10.60 100.00% M6_FUP_FURTHER_COMPLICATION Post-operative course to 6 months (or graft failure if earlier than 6 months) - Other complications - Futher details of above complications E.10.61 100.00% M6_FUP_REJ_EPISODE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Rejection - Number of treated islet rejection episodes since this patients 3 month follow-up form was completed? (No rejection = 0) E.10.62 N/A M6_FUP_FIRST_EPISODE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Rejection - If one or more, date of first episode E.10.63 N/A M6_FUP_PROTOCOL_BIOPSY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Rejection - Were any rejection episodes treated following a protocol biopsy? E.10.64 100.00% M6_FUP_EMP_STATUS Post-operative course to 6 months (or graft failure if earlier than 6 months) - Employment status ('Replace 'work' with 'study' for recipients in full time education) E.10.65 N/A M6_FUP_EMP_OTHER Post-operative course to 6 months (or graft failure if earlier than 6 months) - Employment status ('Replace 'work' with 'study' for recipients in full time education) - Other E.10.66 100.00% M6_FUP_RECURRENT_DISEASE Post-operative course to 6 months (or graft failure if earlier than 6 months) - Has this recipient developed evidence of a primary or recurrent disease in the islet graft since this patients 3 month follow-up form was completed? E.10.67 100.00% M6_FUP_PTLD Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Has the recipient developed post-transplant lymphoproliferative disease (PTLD) or lymphoma since this patients 3 month follow-up form was completed? E.10.68 100.00% M6_FUP_MALIGNANCY Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Has the recipient developed a malignancy since this patients 3 month follow-up form was completed (excluding PTLD, lymphoma and cervical dysplasia)? E.10.69 100.00% M6_FUP_M_TYPE1 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Type of malignancy (malignancy #1) E.10.70 100.00% M6_FUP_M_ICD1 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - ICD10 code (malignancy #1) E.10.71 100.00% M6_FUP_M_DATE1 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Date first diagnosed (malignancy #1) E.10.72 100.00% M6_FUP_M_DONOR1 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Could the malignancy be of donor origin? (malignancy #1) E.10.73 100.00% M6_FUP_M_TYPE2 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Type of malignancy (malignancy #2) E.10.74 100.00% M6_FUP_M_ICD2 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - ICD10 code (malignancy #2) E.10.75 100.00% M6_FUP_M_DATE2 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Date first diagnosed (malignancy #2) E.10.76 100.00% M6_FUP_M_DONOR2 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Could the malignancy be of donor origin? (malignancy #2) E.10.77 100.00% M6_FUP_M_TYPE3 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Type of malignancy (malignancy #3) E.10.78 100.00% M6_FUP_M_ICD3 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - ICD10 code (malignancy #3) E.10.79 100.00% M6_FUP_M_DATE3 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Date first diagnosed (malignancy #3) E.10.80 100.00% M6_FUP_M_DONOR3 Post-operative course to 6 months (or graft failure if earlier than 6 months) - Malignancy details - Could the malignancy be of donor origin? (malignancy #3) E.10.81 100.00% M6_FUP_GFT_FUNC_ASSESSMENT Clinical assessment - Date of clinical assessment of functioning graft (For grafts still functioning, please report an assessment undertaken no earlier than 22 weeks post-transplant) E.10.82 100.00% M6_FUP_INSULIN_INDEPENDENT Clinical assessment - Has the recipient been insulin independent at all since transplant? E.10.83 100.00% M6_FUP_CURRENT_GFT_FUNCTION Clinical assessment - Current graft function E.10.84 100.00% M6_FUP_HBA1C Clinical assessment - IFCC-HbA1c (units: mmol/mol) E.10.85 100.00% M6_FUP_INSULIN_CEASE_DATE Clinical assessment - Date insulin ceased (If currently insulin independent) E.10.86 100.00% M6_FUP_CURRENT_INSULIN_DOSE Clinical assessment - Current insulin dose (If currently partial or no function) (units: unit/24hr) E.10.87 100.00% M6_FUP_INSULIN_RESUMED_DATE Clinical assessment - Date insulin resumed (If previously insulin independent at any time since transplant) E.10.88 100.00% M6_FUP_GLUCOSE_LOWER_DRUG1 Clinical assessment - Glucose lowering drug (For combination treatment only, please enter Drug 1 and Drug 2) - Drug 1 E.10.89 100.00% M6_FUP_GLUCOSE_LOWER_DRUG2 Clinical assessment - Glucose lowering drug (For combination treatment only, please enter Drug 1 and Drug 2) - Drug 2 E.10.90 100.00% M6_FUP_CPEPTIDE Clinical assessment - C-peptide measured between 22 and 26 weeks post-transplant (units: pmol/l) E.10.91 100.00% M6_FUP_CPEPTIDE_DATE Clinical assessment - C-peptide measured between 22 and 26 weeks post-transplant - Measured on E.10.92 100.00% M6_FUP_SERUM_CREATININE Clinical assessment - Serum creatinine measured between 22 and 26 weeks post-transplant (units: umol/l, micro-mole per litre) E.10.93 100.00% M6_FUP_CREATININE_DATE Clinical assessment - Serum creatinine measured between 22 and 26 weeks post-transplant - Measured on E.10.94 100.00% M6_FUP_MEAL_TOLERANCE_DATE Clinical assessment - Date of Meal Tolerance Test E.10.95 100.00% M6_FUP_FASTING_GLUCOSE Clinical assessment - Fasting glucose (units: mmol/l) E.10.96 100.00% M6_FUP_GLUCOSE_90MIN Clinical assessment - 90-minute glucose (units: mmol/l) E.10.97 100.00% M6_FUP_FASTING_CPEPTIDE Clinical assessment - Fasting C-peptide (units: pmol/l) E.10.98 100.00% M6_FUP_CPEPTIDE_90MIN Clinical assessment - 90-minute C-peptide (units: pmol/l) E.10.99 100.00% M6_FUP_RECIPIENT_WEIGHT Clinical assessment - Recipient weight at time of assessment (units: kg) E.10.100 100.00% M6_FUP_CICLOSPORIN Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Ciclosporin E.10.101 N/A M6_FUP_CICLOSPORIN_DOSE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Ciclosporin (If administered) (units: mg/day) E.10.102 100.00% M6_FUP_TACROLIMUS Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Tacrolimus E.10.103 N/A M6_FUP_TACROLIMUS_DOSE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Tacrolimus (If administered) (units: mg/day) E.10.104 100.00% M6_FUP_AZATHIOPRINE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Azathioprine E.10.105 N/A M6_FUP_AZATHIOPRINE_DOSE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Azathioprine (If administered) (units: mg/day) E.10.106 100.00% M6_FUP_MYCOPHENOLATE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Mycophenolate E.10.107 N/A M6_FUP_MYCOPHENOLATE_DOSE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Mycophenolate (If administered) (units: mg/day) E.10.108 100.00% M6_FUP_SIROLIMUS Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Sirolimus/Everolimus E.10.109 N/A M6_FUP_SIROLIMUS_DOSE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Sirolimus/Everolimus (If administered) (units: mg/day) E.10.110 100.00% M6_FUP_PREDNISOLONE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Prednisolone/Prednisone E.10.111 N/A M6_FUP_PREDNISOLONE_DOSE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Prednisolone/Prednisone (If administered) (units: mg/day) E.10.112 100.00% M6_FUP_IMMUNO_OTHER Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Other E.10.113 N/A M6_FUP_IMMUNO_OTHER_DOSE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Other (If administered) (units: mg/day) E.10.114 N/A M6_FUP_IMMUNO_OTHER_NOTE Clinical assessment - Current immunosuppressive drugs at date of assessment (Prior to graft failure for failed grafts, prior to death for deaths with a functioning graft) - Other (If administered)
