Flashcards in Pancreas Transplant for T1DM Deck (16):
What is leading cause of death in T1DM patients under 30 years of age?
What is relationship between hypoglycemia and CVD?
Hypoglycemia may prolong QT interval, which contributes to sudden cardiac death
At what ß-cell mass does diabetes onset start? At what point does glucagon response become affected and labile control set in?
Diabetes onset ~25% islet ß-cell mass
When C-peptide is
What happens to alpha cells and glucagon in advanced T1DM? Initial and Long-term
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)
Three approaches to ß-cell transplant for patients requiring renal replacement:
Pancreas after kidney
Islets after kidney
Approaches to ß-cell transplant for patients with normal kidney
What are effects of corticoids on patients after pancreas transplant?
Pancreas transplant recipients are insulin resistant for first year until weaned off prednisone--
Islet cell responses to hypoglycemia: ß-cell and a-cell
Both become robust/improved compared to base levels
Which method has highest survival rate? Why?
Simultaneous pancreas-kidney transplant-- rejection of kidney is quicker/easier to detect than pancreas rejection...kidney can serve as sentinel for pancreas rejection
Transplantation and Diabetic Nephropathy
Pancreas after kidney tx AND pancreas alone transplantation are effective for reversing nephropathy
Lymphoproliferative Disorder & Tx
Incidence in pancreas alone tx recipients
Incidence much higher in EBV- recipients
Is diseased pancreas removed in PAK Tx?
Nah they leave that useless shit in there
Factors Influencing Success of Pancreas Tx
Recipient age, BMI, presence/absence of coronary artery disease
Donor age and BMI
What is the process of Islet transplant?
What is secretory capacity after islet transplantation?
It ends up being 50-60% of normal levels-- probably due to loss during engraftment process....still sufficient