Introduction:  Gastroparesis is a relatively common feature of individuals with type 1 diabetes mellitus referred for pancreas transplantation.  It is widely recognised that failing to fulfil nutritional requirements post-transplant can be associated with delayed wound healing and repeated hospitalisations.  An audit by the dietetics department found no consistency with the documentation of gastroparesis in referred patients.   
Method:  The Gastroparesis Cardinal Symptoms Index was introduced as means of objectively evaluating the prevalence and spectrum of this syndrome before pancreas transplantation.  A total of 52 patients were evaluated using the tool from November 2014 – January 2016.  Post-operative nutritional data, weight and length of stay were collected on these 52 patients.
Results:  Of the 52 patients evaluated 13 were identified as high scorers.  These patients experienced exacerbations of gastroparesis post-transplant with significant nutritional deficits.  Of these 13 patients 9 had undergone simultaneous pancreas and kidney transplant and 4 had a pancreas transplant alone.
In the SPK cohort: 8/9 not meeting 50% nutritional requirement by day 7 despite being offered nutritional supplements.
In the PTA cohort: 4/4 patients did not meet 50% nutritional requirements by day 7.  Length of stay was not influenced by the GCSI score.
Conclusion: Individuals with gastroparesis can be a neglected group. It is unclear if this group is at higher risk of graft loss than others. The GCSI score can be used, in addition to clinical judgement, to assess the severity of gastroparesis and the need for additional dietetic support.
Currently used nutritional measure are insufficient in determining nutritional deficits or the risk of developing a nutritional deficit. Using other tools in conjunction with the GCSI index may help improve pre and post-transplant management.
All patients with a high gastroparesis score need dietetic input and a specialist enteral feeding agreed at time of transplant listing, which can be amended with changes in clinical circumstances.
The audit highlighted the need to increase MDT awareness regarding proactive approaches in improving nutritional management of high scorer’s pre and post-transplant.
Intraoperative placement of a jejunostomy feeding tube would be a potential strategy to ensure improved nutritional status and would avoid any risk to the transplant anastomosis by later placement of naso-jejunal tubes. While further refinement of the GCSI tool may be needed the interpretation of a GCSI score must be placed in a clinical context.