Select
ID
Name
Description
1966 Recipient Details - Follow-up Centre
Text
1967 Recipient Details - Centre code
Format: string up to 6 characters
1968 Recipient Details - ODT Recipient number
Format: string up to 6 characters
1969 Recipient Details - ODT Transplant ID
Format: string up to 6 characters
1970 Recipient Details - Hospital number
Text
1971 Transfer and non-attendance - The patient has transferred to another unit for follow-up
Categories:
1972 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
Categories:
1973 Transfer and non-attendance - The patient is considered lost to follow-up. Further contact with the patient is not expected
Categories:
1974 Transfer and non-attendance - Follow-up details - Further details
Text
1975 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)
Format: DD/MM/YYYY
1976 Post-operative course - Number of treated pancreas rejection episodes in the last 12 months (0 = no rejection)
Format: number
1977 Post-operative course - For first annual assessment only, please enter date of first episode after this transplant
Format: DD/MM/YYYY
1978 Post-operative course - Employment status (`Replace `work` with `study` for recipients in full time education)
Categories:
1979 Post-operative course - Employment status (`Replace `work` with `study` for recipients in full time education) - Other
Text
1980 Post-operative course - Smoking - Pipe / Cigars
Categories:
1981 Post-operative course - Smoking - Cigarettes
Categories:
1982 Post-operative course - Smoking - If YES, no./day (Cigarettes)
Format: string up to 2 characters
1983 Post-operative course - Smoking - If Ex, years since stop (To nearest years, 6 months = 1 year)
Format: string up to 2 characters
1984 Post-operative course - Has this recipient developed evidence of a primary or recurrent disease in the islet graft during the past 12 months?
Categories:
1985 Post-operative - Malignancy details - Has the recipient developed post-transplant lymphoproliferative disease (PTLD) or lymphoma in the 12 months?
Categories:
1986 Post-operative - Malignancy details - Has the recipient developed a malignancy in the 12 months (excluding PTLD, lymphoma and cervical dysplasia)?
Categories:
1987 Post-operative - Malignancy details - Type of malignancy (malignancy #1)
Format: Text
1988 Post-operative - Malignancy details - ICD10 code (malignancy #1)
Format: string up to 4 characters
1989 Post-operative - Malignancy details - Date first diagnosed (malignancy #1)
Format: DD/MM/YYYY
1990 Post-operative - Malignancy details - Could the malignancy be of donor origin? (malignancy #1)
Categories:
1991 Post-operative - Malignancy details - Type of malignancy (malignancy #2)
Format: Text
1992 Post-operative - Malignancy details - ICD10 code (malignancy #2)
Format: string up to 4 characters
1993 Post-operative - Malignancy details - Date first diagnosed (malignancy #2)
Format: DD/MM/YYYY
1994 Post-operative - Malignancy details - Could the malignancy be of donor origin? (malignancy #2)
Categories:
1995 Post-operative - Malignancy details - Type of malignancy (malignancy #3)
Format: Text
1996 Post-operative - Malignancy details - ICD10 code (malignancy #3)
Format: string up to 4 characters
1997 Post-operative - Malignancy details - Date first diagnosed (malignancy #3)
Format: DD/MM/YYYY
1998 Post-operative - Malignancy details - Could the malignancy be of donor origin? (malignancy #3)
Categories:
1999 Graft and recipient status - Has the pancreatic islet graft failed? (C-peptide<50pmol/l) (Recipient died with a functioning graft, please record as failed with reason 90, death with functioning graft)
Categories:
2000 Graft and recipient status - Date of failure (date C-peptide recorded below 50pmol/l)
Format: DD/MM/YYYY
2001 Graft and recipient status - Cause of failure
Categories:
2002 Graft and recipient status - Other identified cause of failure
Text
2003 Graft and recipient status - Has the recipient died?
Categories:
2004 Graft and recipient status - Date of death
Format: DD/MM/YYYY
2005 Graft and recipient status - Cause of death - Primary
Categories:
2006 Graft and recipient status - Cause of death - Primary - Other identified cause of death
Text
2007 Graft and recipient status - Cause of death - Secondary
Categories:
2008 Graft and recipient status - Cause of death - Secondary - Other identified cause of death
Text
2009 Post-transplant complications - Total number of days as inpatient during the last 12 months (Excluding transplant admission)
Format: string up to 3 characters
2010 Post-transplant complications - Number of readmissions over the last 12 months (0 = No readmissions)
Format: string up to 2 characters
2011 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Number of severe hypoglycaemia events
Format: string up to 2 characters
2012 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - If one or more, date of first event
Format: DD/MM/YYYY
2013 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Number of admissions with diabetic ketoacidosis
Format: string up to 2 characters
2014 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - If one or more, date of first admission
Format: DD/MM/YYYY
2015 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Angina
Categories:
2016 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Myocardial infarction
Categories:
2017 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - PCI
Categories:
2018 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Coronary artery bypass graft
Categories:
2019 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Transient ischemic attack
Categories:
2020 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - CVA
Categories:
2021 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Intermittent claudication
Categories:
2022 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - PVD intervention
Categories:
2023 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Foot ulceration
Categories:
2024 Post-transplant complications - Diabetic complications (Please indicate complications that have occurred during the last 12 months post-transplant, last 6 months for first annual assessment) - Limb amputation
Categories:
2025 Post-transplant complications - Diabetic eye disease - Diabetic retinopathy confirmed by dilated digital photography
Categories:
2026 Post-transplant complications - Diabetic eye disease - Registered blind
Categories:
2027 Post-transplant complications - Diabetic eye disease - Laser photocoagulation
Categories:
2028 Post-transplant complications - Diabetic eye disease - Cataract
Categories:
2029 Post-transplant complications - Diabetic eye disease - Vitreous haemorrhage
Categories:
2030 Post-transplant complications - Diabetic eye disease - Vitrectomy
Categories:
2031 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Proteinuria
Categories:
2032 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Ulceration
Categories:
2033 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Postural hypotension
Categories:
2034 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Erectile/sexual dysfunction
Categories:
2035 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Peripheral neuropathy
Categories:
2036 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Gastroparesis
Categories:
2037 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Autonomic sweating
Categories:
2038 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Charcot foot
Categories:
2039 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Neuropathic pain score (0-10, 0 = no pain)
Format: number
2040 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Diabetic enteropathy
Categories:
2041 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Autonomic bladder dysfunction
Categories:
2042 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Cheiroarthropathy
Categories:
2043 Post-transplant complications - Nephropathy / neuropathy / musculoskeletal (record current status) - Mononeuropathy
Categories:
2044 Post-transplant complications - Other autoimmune disease - Thyroid disease
Categories:
2045 Post-transplant complications - Other autoimmune disease - Addison`s disease
Categories:
2046 Post-transplant complications - Other autoimmune disease - Coeliac disease
Categories:
2047 Post-transplant complications - Other complications - Has the recipient required readmission due to complications?
Categories:
2048 Post-transplant complications - Other complications - Portal vein / hepatic haemorrhage
Categories:
2049 Post-transplant complications - Other complications - Portal vein thrombosis
Categories:
2050 Post-transplant complications - Other complications - Perforated gall bladder
Categories:
2051 Post-transplant complications - Other complications - CMV infection
Categories:
2052 Post-transplant complications - Other complications - Viral systemic infection
Categories:
2053 Post-transplant complications - Other complications - Other
Categories:
2054 Post-transplant complications to 6 months (or graft failure if earlier than 6 months) Other complications - Urinary tract infection (UTI) - Other
Categories:
2055 Post-transplant complications - Other complications - Bacterial systemic infection
Categories:
2056 Post-transplant complications - Other complications - Intraperitoneal abscess
Categories:
2057 Post-transplant complications - Other complications - Fungal systemic infection
Categories:
2058 Post-transplant complications - Other complications - Number of laparotomies performed since transplant? (No laparotomies = 0)
Format: number
2059 Post-transplant complications - Other complications - Futher details of above complications
Text
2060 Post-transplant complications - Other complications - Has the recipient become registered blind in the last 12 months?
Categories:
2061 Post-transplant complications - Visual acuity - Right Eye (6/6, 6/9, 6/12 etc., CF for counting fingers, HM for hand movements at 1 metre, LP for light perception, NP for no light perception)
Format: string up to 3 characters
2062 Post-transplant complications - Visual acuity - Left Eye (6/6, 6/9, 6/12 etc., CF for counting fingers, HM for hand movements at 1 metre, LP for light perception, NP for no light perception)
Format: string up to 3 characters
2063 Clinical assessment - Date of clinical assessment of functioning graft (For grafts still functioning, please report an assessment undertaken no earlier than 11 months post-transplant)
Format: DD/MM/YYYY
2064 Clinical assessment - Has the recipient been insulin independent in the last 12 months (Last 6 months for first annual assessment)?
Categories:
2065 Clinical assessment - Current graft function
Categories:
2066 Clinical assessment - IFCC-HbA1c (units: mmol/mol)
Format: string up to 3 characters
2067 Clinical assessment - Date insulin ceased (If currently insulin independent)
Format: DD/MM/YYYY
2068 Clinical assessment - Current insulin dose (If currently partial or no function) (units: unit/24hr)
Format: string up to 3 characters
2069 Clinical assessment - Date insulin resumed (If previously insulin independent at any time since transplant)
Format: DD/MM/YYYY
2070 Clinical assessment - Glucose lowering drug (For combination treatment only, please enter Drug 1 and Drug 2) - Drug 1
Categories:
2071 Clinical assessment - Glucose lowering drug (For combination treatment only, please enter Drug 1 and Drug 2) - Drug 2
Categories:
2072 Clinical assessment - C-peptide measured nearest graft anniversary (For the first annual assessment please report level measured between 11 and 13 months post transplant) (units: pmol/l)
Format: string up to 4 characters
2073 Clinical assessment - C-peptide measured nearest graft anniversary (For the first annual assessment please report level measured between 11 and 13 months post transplant) - Measured on
Format: DD/MM/YYYY
2074 Clinical assessment - Serum creatinine measured nearest graft anniversary (For the first annual assessment please report level measured between 11 and 13 months post transplant) (units: umol/l, micro-mole per litre)
Format: string up to 4 characters
2075 Clinical assessment - Serum creatinine measured nearest graft anniversary (For the first annual assessment please report level measured between 11 and 13 months post transplant) - Measured on
Format: DD/MM/YYYY
2076 Clinical assessment - Date of Meal Tolerance Test
Format: DD/MM/YYYY
2077 Clinical assessment - Fasting glucose (units: mmol/l)
Format: string up to 3 characters
2078 Clinical assessment - 90-minute glucose (units: mmol/l)
Format: string up to 3 characters
2079 Clinical assessment - Fasting C-peptide (units: pmol/l)
Format: string up to 4 characters
2080 Clinical assessment - 90-minute C-peptide (units: pmol/l)
Format: string up to 4 characters
2081 Clinical assessment - Recipient weight at time of assessment (units: kg)
Format: string up to 4 characters
2082 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
Categories:
2083 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)
Format: string up to 5 characters
2084 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
Categories:
2085 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)
Format: string up to 5 characters
2086 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
Categories:
2087 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)
Format: string up to 5 characters
2088 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
Categories:
2089 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)
Format: string up to 5 characters
2090 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
Categories:
2091 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)
Format: string up to 5 characters
2092 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
Categories:
2093 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)
Format: string up to 5 characters
2094 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
Categories:
2095 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)
Format: string up to 5 characters
2096 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)
Text
