Pancreas Transplant for T1DM

Question 1

What is leading cause of death in T1DM patients under 30 years of age?

Answer 1

Severe hypoglycemia

Question 2

What is relationship between hypoglycemia and CVD?

Answer 2

Hypoglycemia may prolong QT interval, which contributes to sudden cardiac death

Question 3

At what ß-cell mass does diabetes onset start? At what point does glucagon response become affected and labile control set in?

Answer 3

Diabetes onset ~25% islet ß-cell mass

When C-peptide is

Question 4

What happens to alpha cells and glucagon in advanced T1DM? Initial and Long-term

Answer 4

Normally it is inhibited by insulin; but in its absence, initially have high glucagon secretion…

After repeated hypoglycemic episodes also lose ability to defend against hypoglycemia via glucagon (due to hypoglycemia associated-autonomic failure)

Question 5

Three approaches to ß-cell transplant for patients requiring renal replacement:

Answer 5

Simultaneous pancreas-kidney
Pancreas after kidney
Islets after kidney

Question 6

Approaches to ß-cell transplant for patients with normal kidney

Answer 6

Pancreas alone

Islet alone

Question 7

What are effects of corticoids on patients after pancreas transplant?

Answer 7

Pancreas transplant recipients are insulin resistant for first year until weaned off prednisone–

Question 8

Islet cell responses to hypoglycemia: ß-cell and a-cell

Answer 8

Both become robust/improved compared to base levels

Question 9

Which method has highest survival rate? Why?

Answer 9

Simultaneous pancreas-kidney transplant– rejection of kidney is quicker/easier to detect than pancreas rejection…kidney can serve as sentinel for pancreas rejection

Question 10

Transplantation and Diabetic Nephropathy

Answer 10

Pancreas after kidney tx AND pancreas alone transplantation are effective for reversing nephropathy

Question 11

Lymphoproliferative Disorder & Tx

Answer 11

Incidence in pancreas alone tx recipients

Incidence much higher in EBV- recipients

Question 12

Is diseased pancreas removed in PAK Tx?

Answer 12

Nah they leave that useless shit in there

Question 13

Factors Influencing Success of Pancreas Tx

Answer 13

Recipient age, BMI, presence/absence of coronary artery disease

Donor age and BMI

Question 14

What is the process of Islet transplant?

Answer 14

Intrahepatic engraftment

Question 15

What is secretory capacity after islet transplantation?

Answer 15

It ends up being 50-60% of normal levels– probably due to loss during engraftment process….still sufficient

Question 16

What happens to hepatic/peripheral insulin sensitivity after islet tx?

Answer 16

Hepatic insulin sensitivity ~ controls

Peripheral insulin sensitivity greatly improved though slightly below controls