Expansion in living donor transplants, altruistic donors, paired exchange transplants, desensitisation before living donor transplant, high risk donor and recipient transplantation, increasing transplantation of DCD organs, innovative work in the care of ‘transition’ patients.

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The Oxford Transplant Centre (OTC) is one of seven national centres performing pancreas transplantation in the UK. The OTC centre performs 70-80 pancreas transplants annually, and is the world’s largest centre offering pancreas transplantation. We regularly audit the outcomes of our pancreas transplantation programme. The results our programme produces are recognised both nationally and internationally as delivering outcomes of a high standard.

The Oxford Pancreas Transplant Programme offers patients the opportunity to be seen at Pancreas Transplant pre-assessment clinics in Dorset, Bristol, Royal Free London, Portsmouth and Plymouth. This allows the patient to be seen as far as possible at a location near to their home.

Pancreas transplantation is a procedure usually performed to treat patients who have a failure of their pancreas to produce insulin, most often due to 'type 1' diabetes. This is where the insulin secreting cells ‘islets’, found in the pancreas have been destroyed by the patient’s own immune system - an autoimmune disease. Pancreas transplantation is performed using pancreases retrieved from cadaveric (deceased) donors.

Most patients receive their pancreas at the same time as a kidney transplant, a procedure called 'simultaneous kidney/pancreas graft' (SPK). This is an option for patients who have kidney failure caused by long-term diabetes.

Some diabetic patients who have had a previous kidney transplant then go on later to have a pancreas transplant ('pancreas after kidney (PAK)').

Occasionally patients who have found severe difficulties controlling their diabetes and have early signs of kidney failure are transplanted with a 'pancreas transplant alone' (PTA).

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Islet transplantation is a minimally invasive procedure that has the potential to reverse type 1 diabetes. It involves the extraction (isolation) of the insulin-producing tissue (the islets) from a donor pancreas and infusing these into the liver of a patient with T1DM. Over recent years, islet transplantation has resulted in considerable success with up to 85% of selected patients coming off insulin following this procedure.

Oxford has been involved in developing human islet isolation and islet transplantation over the past 30 years. It is now one of the leading centres in Europe and is internationally recognised. Clinically, we have an active islet transplant programme with patients referred from a wide geographical region. In addition to weekly clinics in the Oxford Centre for Diabetes, Endocrinology, and Metabolism (OCDEM), we run a peripheral clinic in Birmingham, and will shortly be starting one in Southampton. The Oxford DRWF Human Islet Isolation Facility is one of a few 'state of the art; purpose built clean room facility and provides human islets for the UK islet Transplant Consortium. In addition, we provide research islets for a wide range of research projects within Oxford and throughout the UK, and are a designated Juvenile Diabetes Research Foundation (JDRF) Islet Resource Centre.

The Oxford Consortium for Islet Transplantation (OXCIT) is a multidisciplinary research collaboration that links a number of different Research Groups working on a wide-range of islet / diabetes related projects. The Islet Transplant Research Group is actively involved in 3 broad areas of research, namely: 1) Optimisation of Islet Isolation (with particular emphasis on understanding the molecular structure of the pancreatic matrix); 2) Islet pre-conditioning (investigating optimal islet oxygenation and novel macro-encapsulation transplantable devices); and islet development (focussing on the role of foregut mesenchyme). We have recently received significant funding from both the NIHR and the FP7 European Grant round, and have current / previous funding from MRC, Wellcome, JDRF, DRWF, and RCS (Eng).

Professor Paul Johnson
Director of the Oxford islet Transplant Programme

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One of only 4 units in UK and only 2 doing adult intestinal transplants. 26 transplants carried out since unit designated in 2008. Pioneered concomitant transplantation of abdominal wall (in conduction with plastic and reconstructive surgeons) in patients in whom the abdominal capacity is so reduced as to make transplantation otherwise impossible. Pioneered use of sentinel vascularised skin flap as a means of monitoring the immune response and picking up rejection before there is significant damage to the lining of the bowel.

Intestinal transplant is an operation to replace diseased or shortened bowel with the healthy bowel from a donor. Small bowel transplant may be an option for those individuals whose bowel no longer works and are dependent on being fed via total parenteral nutrition (TPN), liquid feed via a vein into the body. It may become necessary for some individuals on TPN to consider a small bowel transplant if their liver shows signs of damage from the TPN or if they have problems with intravenous line infections or even lose line access.

Bowel transplant have been performed in Oxford since 2008 and internationally since the 1960s.To date the Oxford University Hospitals trust has performed 16 transplants. Following small bowel transplant patients can be weaned of TPN onto a normal oral diet.

A multi-disciplinary team approach is paramount in the success of this transplant. Patients are rigorously assessed by a multi-disciplinary team before being deemed fit for the transplant.

Small bowel transplantation is a complicated and difficult operation that comes with risks. In the past there were high rates of rejection of the new organ. In recent times with the development of medicines to manage rejection, immunosuppression, and greater experience survival rates are improving.

For further information on small bowel transplant please contact: Lydia.smith@ouh.nhs.uk

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The Transplant Immunology and Immunogenetics Laboratory provides consultant-lead specialist services for clinical transplantation within the Oxford Transplant Centre and for haematopoietic stem cell transplants performed within the Oxford University Hospitals NHS Trust (OUH). Currently these services include HLA typing to the DNA sequence level, antibody screening and specification, crossmatching and monitoring T lymphocytes for drug tailoring. The laboratory provides a 24-hour on-call service for transplantation and post-transplant monitoring. Immunogenetics services are also provided to clinicians to define disease susceptibility genes as an aid to patient diagnosis and treatment. The laboratory is accredited by Clinical Pathology Accreditation and European Federation for Immunogenetics. Referrals are received from within the Oxford University Hospitals Trust and externally from Primary Care Trusts and other Trusts and Institutions.

In order to maintain the highest standards of the services in a continually developing field, we are involved in research and development in histocompatibility and immunogenetics and in the broader field of clinical transplantation.

Professor Susan Fuggle

The Oxford Transplant Centre is committed to training and education at both undergraduate and postgraduate level. Throughout the calendar year a number of 4th year and 6th year medical students undertake a surgical placement on the transplant unit. This gives them the opportunity to be exposed not just to transplantation but to clinical surgery. They are closely supervised and mentored as they undertake clinical examination of patients and are taught many aspects of both surgery and transplantation through organised tutorials and bed side teaching.

In addition to the undergraduate clinical students from the Oxford Medical School, the transplant centre regularly has visiting students from overseas medical schools undertake a clinical elective placement. These visiting students are usually in their final year of training and wish to experience health care in another country and culture. The Oxford Transplant Centre is committed to accommodating such students and providing them with teaching and exposure to not just transplantation but the NHS.

We have a high turn-over of postgraduate doctors in training who spend anything from 3 months to a year on placement within the transplant centre. They contribute to the care of all patients in both the inpatient and outpatient setting as well as in the operating theatres. The trainees are closely supervised and educated around specific aspects of transplantation and access for dialysis. As a consequence of committed teaching and training a number of trainees have declared a career interest in transplantation.

In the past year the education and training programme has evolved to provide specialist training opportunities for overseas doctors who are at the end of their training and are ready to become consultants. We have enabled doctors from around the world to experience transplantation at Oxford as well as the NHS.

The longer term vision is to develop transplant education and training programmes that incorporate nephrology trainees and allied health professionals by generating a Centre of Excellence for Teaching and Learning thereby generating the next generation of renal failure and transplant specialists.