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Chapter 31: Transplantation and Immunology

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Which of the following is an indication for pancreas transplantation?

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(A) Poor glycemic control caused by lack of compliance with the prescribed insulin regimen

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(B) New-onset type 1 diabetes in a 10-year-old child

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(C) Body mass index (BMI) greater than 35 with poor glycemic control

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(D) Type 1 diabetes with diabetic nephropathy

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(E) Poor glycemic control in a 17-year-old on subcutaneous insulin injections

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(D) The first human pancreas transplant was performed in 1966. Since that time, the pancreas transplant has been used to establish normoglycemia and insulin independence, as well as prevent end-organ damage in diabetic recipients. Indications for pancreas transplantation are previous total pancreatectomy, disabling or life-threatening hypoglycemic unawareness, and presence or high risk of secondary complications of diabetes.

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BIBLIOGRAPHY

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Humar A, Dunn DL. Transplantation. In: Brunicardi F, Andersen DK, Billiar TR, et al., (eds.), Schwartz’s Principles of Surgery. 9th ed. New York, NY: McGraw-Hill; 2010: Chapter 11.

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White SA, Shaw JA, Sutherland DER. Pancreas transplantation. Lancet 2009;373(9677):1808–1817.

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Which of the following is true regarding potential cadaveric organ donors?

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(A) Brain death is a clinical diagnosis that can be determined by a single physician.

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(B) Nuclear scintigraphic determination of brain blood flow must be accompanied by electroencephalographic (EEG) electrocerebral silence to be considered confirmatory.

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(C) Consent for organ donation is best obtained by the transplant surgery team.

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(D) After the period of preoxygenation, hypocarbia with an arterial carbon dioxide tension (PaCO2) less than 60 mmHg should be documented.

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(E) Reversible causes of comatose state must be excluded (i.e., hypothermia, neuromuscular blockade, shock).

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(E) Prior to organ donation, the diagnosis of brain death must be made by two physicians at a given interval depending on the patient’s age. The diagnosis of brain death is a clinical one. Criteria include normothermia, absence of drug intoxication, coma, absence of motor reflexes, absence of pupillary responses to light, absence of corneal reflexes, absence of caloric responses, absence of gag, absence of coughing in response to tracheal suctioning, absence of sucking or rooting reflex, and absence of respiratory drive at aPaCO2 that is 60 mmHg or 20 mmHg above normal baseline values.

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In addition to clinical diagnosis, confirmatory testing can be performed, including cerebral angiography, nuclear imaging, transcranial Doppler ultrasonography, and EEG. Confirmatory testing in adults is optional, but at least one confirmatory test is required in ...

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