Pancreas Transplant for T1DM Flashcards Preview

Endocrinology > Pancreas Transplant for T1DM > Flashcards

Flashcards in Pancreas Transplant for T1DM Deck (16):
1

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

Severe hypoglycemia

2

What is relationship between hypoglycemia and CVD?

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

3

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

4

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)

5

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

Simultaneous pancreas-kidney
Pancreas after kidney
Islets after kidney

6

Approaches to ß-cell transplant for patients with normal kidney

Pancreas alone
Islet alone

7

What are effects of corticoids on patients after pancreas transplant?

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

8

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

Both become robust/improved compared to base levels

9

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

10

Transplantation and Diabetic Nephropathy

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

11

Lymphoproliferative Disorder & Tx

Incidence in pancreas alone tx recipients
Incidence much higher in EBV- recipients

12

Is diseased pancreas removed in PAK Tx?

Nah they leave that useless shit in there

13

Factors Influencing Success of Pancreas Tx

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

Donor age and BMI

14

What is the process of Islet transplant?

Intrahepatic engraftment

15

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

16

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

Hepatic insulin sensitivity ~ controls
Peripheral insulin sensitivity greatly improved though slightly below controls