Pancreas and Islet Transplantation Flashcards
What are 2 systems of defense against hypoglycemia?
Islet cells -> Glucagon secretion
Sympathoadrenal response -> epinephrine secretion
What’s the leading cause of death in T1D patients < 30 yrs in age?
Severe hypoglycemia -> prolonged QT interval -> sudden cardiac death.
Why does exposure to hypoglycemia increase the risk of severe hypoglycemia?
Repeated exposure to hypoglycemia blunts the autonomic, sympathoadrenal response to it. Hypoglycemia-Associated Autonomic Failure (HAAF).
Transplanted pancreases tend to be survive better when given simultaneously with a kidney. Why might this be?
Declining kidney function is easier to detect, and rejection can be treated early to prevent organ loss.
Does insulin secretion and glucagon secretion return to normal to with pancreas transplant? How about epinephrine?
Yes, insulin and glucagon secretion seem to work well.
Epinephrine function is often not (fully) restored (perhaps because there’s autonomic neuropathy that can’t be reversed).
Is endogenous liver glucose production restore by pancreas transplant?
Yes.
Do transplanted pancreases help keep a transplanted kidney alive?
Yes, but a live-donor kidney still does better than a deceased-donor kidney.
Where do you put the cells you give during islet transplant? Why might this be helpful?
Into the liver. This is a well-oxygenated area.
What do you do right after islet transplantation?
Keep patients on insulin for a while - let beta cells “epithelialize” before stressing them.
What’s really the point of islet transplantation?
Protection against hypoglycemia. Patients may still require insulin.
Does islet cell transplant restore glucagon activity? Epinephrine?
Yep. And yes. (to “normal” levels, probably not, but good enough to prevent hypoglycemia)
