Lecture 12: Pancreas and Islet Transplantation for Type 1 Diabetes

Question 1

What is dead in bed syndrome of T1D?

Answer 1

Low glycemic levels while sleeping

Question 2

How does severe hypoglycemia lead to death?

Answer 2

Long QT interval

Cardiac arrest

Question 3

What are the primary responses to battle hypoglycemia?

Answer 3

1. primary defense islet cell responses

2. secondary defense sympathoadrenal responses (epinephrine release)

Question 4

What is hypoglycemia associated autonomic failure (HAAF)?

Answer 4

When the secondary defense against hypoglycemia is lost

No epinephrine to fight hypoglycemia

Question 5

In what type of diabetes is pancreatic and islet transportation indicated?

Answer 5

T1D

Question 6

What are the approaches to Beta-cell replacement?

Answer 6

1. Simultaneous pancreas-kidney
2. Pancreas after kidney
3. Islets after kidney
4. Simultaneous islet kidney
   Patients with normal kidney function:
5. pancreas alone
6. islet alone

Question 7

What do you do simultaneous kidney pancreas transplant?

Answer 7

90% survival for BOTH kidney and pancreas
However, 80% survival rate if just the pancreas
Due to immunologic failure
When pancreas and kidney are transplanted together, the donor is the same

Question 8

What type of transplant has the best results?

Answer 8

Pancreas and kidney transplant simultaneous

Question 9

What accounts for surgical failure in the early stages of pancreas transplant? Later on post-surgically?

Answer 9

First it is technical

Second it is immunologic

Question 10

What are the effects of pancreas transplantation of diabetic nephropathy?

Answer 10

Glomerulus structure restored

Question 11

What is the recommendation for transplant?

Answer 11

Recommendation is to get kidney first if nothing else available

Question 12

What are the factors influencing graft and patient survival?

Answer 12

1. recipient age < 30kg/m^2

All good shit

Question 13

How do you transplant islet cells?

Answer 13

You take islet cells from a donor and you inject it into the portal vein into the recipient
Islet cells manifest itself in liver

Question 14

What happens after an islet transplant?

Answer 14

After transplant you get an 
Epinephrine response
Insulin response
glucagon response
cortisol response
growth hormone response
Restoration of the counter regulation system
Done in HEALTHY patients (no microvascular complications

Question 15

When do you need surgical transplant of pancreas and kidney?

Answer 15

When man has a diabetic nephropathy