CCTN Transplant Certification Exam Prep
Questions with Correct Solutions
pancreas - ANSWER Wahooo diabetes :)
What are the goals of a pancreas Tx - ANSWER To restore normoglycemia in pts with labile
diabetes
To halt or prevent secondary complications of diabetes
What complications can hyperglycemia cause (macrovascular, microvascular, autonomic) -
ANSWER Microvascular: diabetic nephropathy (leading cause of ESRD), diabetic retinopathy
Macrovascular: MI, CVA, peripheral artery disease
Autonomic: gastroperesis, peripheral neuropathy, neurogenic bladder, sexual dysfunction,
orthostatic hypotension
what are the definitions of a PTA, SPK, PAK - ANSWER Pancreas transplant Alone
simultaneous pancreas- kidney transplant
Pancreas after kidney transplant
What is a c-peptide test used to determine, what does it mean if it is high and low - ANSWER
This is used to test if you have type 1 DM or 2 DM
Beta cells in your pancreas make insulin. During that process, these cells also release C-peptide.
This substance doesn't actually affect your blood sugar. But you can measure the level of it to
help figure out how much insulin you're making.
Normal range: 0.5 to 2.0 nanograms per min
High: Have insulin resistance -- meaning your body doesn't use it as well as it should; if you have
type 2 diabetes, your insulin levels may be high.
,Low: You have type 1 or type 2 diabetes
You are on insulin shots and it is suppressing the release of insulin from your pancreas
You have low blood sugar so your pancreas stops releasing insulin
For a PTA and PAK what criteria do people have to meet? - ANSWER On insulin and a c-peptide
greater than 2ng/ml
On insulin and a c-peptide less than 2ng/ml and a BMI less than or equal to the maximum
allowable ( < 28 kg/m)
pancreatic endocrine deficiency
patients w/ DM2 are rarely considered
For a SPK what criteria do people have to meet - ANSWER Diagnosis of DM or pancreatic
exocrine insufficiency with renal insufficiency
What are some eligibility criteria? ( depends on each transplant center) - ANSWER 1) C-peptide
deficiency
2) Frequent or severe metabolic complications (hypo-hyperglycemia, ketoacidosis,
hypoglycemia unawareness despite optimized medical management
3) secondary complications: peripheral neuropathy, retinopathy, gastropresis, CAD
4) numbness tingling, loss of perception of extremities, lethargy, nausea, dizziness, blurred
vision, blindness, low vision
What are some medical risks and psychosocial risks for a pancreas tx - ANSWER Medical:
Wound infection, pneumonia, blood clot formation, organ rejection/ failure, immunospression
therapy, arrhytmias, cardiovascular collapse, multiorgan failure death
psychosocial: depression, PTSD, generalized anxiety, feelings of guilt, financial difficulties
what qualifications does the National tx program do transplant centers have to meet? -
ANSWER 1 year of patient and graft survival
, If the center does not meet outcomes Medicare B will not pay for immunosuppression
medications
what are some organ donor risk factors - ANSWER medical, social hx related to age of donor
condition of the organ
disease transmission ( human immunodeficiancy virus, hepatitis B, and hepatitis C, cancer,
malaria, disease not detectable at the time of transplant)
What is the standard immunosuppression used - ANSWER Prograf, cellcept, prednisione
Do the doctors remove native kidneys or pancreas? - ANSWER No, this allows the exocrine
function of the native pancreas to be preserved
what are the two surgical approaches to handle exocrine secretions produced by the
transplanted pancreas - ANSWER Enteric drainage (bowel drainage)
Bladder drainage
what happens when the surgeon does enteric drainage to manage exocrine secretions and
what is the benefit of the drainage - ANSWER About 2L of the enzymatic fluid and bicarbonate
produced by the pancreas is reabsorbed in the bowel
The donor portal vein is anastomosed to the side of the recipient's superior mesenteric vein,
the transplanted donor duodenal segment is attached to the recipient's jejunum to establish
exocrine drainage
Benefits of ED drainage: is that no fluid and electrolyte changes occur post-transplant due to its
similarity to the natural anatomy
what happens when the doctor does bladder drainage and what are the benefits - ANSWER This
directs venous outflow and insulin drainage into the iliac vein, exocrine drainage is via
anastomosis of a donor duodenal segment to the recipients urinary bladder
Questions with Correct Solutions
pancreas - ANSWER Wahooo diabetes :)
What are the goals of a pancreas Tx - ANSWER To restore normoglycemia in pts with labile
diabetes
To halt or prevent secondary complications of diabetes
What complications can hyperglycemia cause (macrovascular, microvascular, autonomic) -
ANSWER Microvascular: diabetic nephropathy (leading cause of ESRD), diabetic retinopathy
Macrovascular: MI, CVA, peripheral artery disease
Autonomic: gastroperesis, peripheral neuropathy, neurogenic bladder, sexual dysfunction,
orthostatic hypotension
what are the definitions of a PTA, SPK, PAK - ANSWER Pancreas transplant Alone
simultaneous pancreas- kidney transplant
Pancreas after kidney transplant
What is a c-peptide test used to determine, what does it mean if it is high and low - ANSWER
This is used to test if you have type 1 DM or 2 DM
Beta cells in your pancreas make insulin. During that process, these cells also release C-peptide.
This substance doesn't actually affect your blood sugar. But you can measure the level of it to
help figure out how much insulin you're making.
Normal range: 0.5 to 2.0 nanograms per min
High: Have insulin resistance -- meaning your body doesn't use it as well as it should; if you have
type 2 diabetes, your insulin levels may be high.
,Low: You have type 1 or type 2 diabetes
You are on insulin shots and it is suppressing the release of insulin from your pancreas
You have low blood sugar so your pancreas stops releasing insulin
For a PTA and PAK what criteria do people have to meet? - ANSWER On insulin and a c-peptide
greater than 2ng/ml
On insulin and a c-peptide less than 2ng/ml and a BMI less than or equal to the maximum
allowable ( < 28 kg/m)
pancreatic endocrine deficiency
patients w/ DM2 are rarely considered
For a SPK what criteria do people have to meet - ANSWER Diagnosis of DM or pancreatic
exocrine insufficiency with renal insufficiency
What are some eligibility criteria? ( depends on each transplant center) - ANSWER 1) C-peptide
deficiency
2) Frequent or severe metabolic complications (hypo-hyperglycemia, ketoacidosis,
hypoglycemia unawareness despite optimized medical management
3) secondary complications: peripheral neuropathy, retinopathy, gastropresis, CAD
4) numbness tingling, loss of perception of extremities, lethargy, nausea, dizziness, blurred
vision, blindness, low vision
What are some medical risks and psychosocial risks for a pancreas tx - ANSWER Medical:
Wound infection, pneumonia, blood clot formation, organ rejection/ failure, immunospression
therapy, arrhytmias, cardiovascular collapse, multiorgan failure death
psychosocial: depression, PTSD, generalized anxiety, feelings of guilt, financial difficulties
what qualifications does the National tx program do transplant centers have to meet? -
ANSWER 1 year of patient and graft survival
, If the center does not meet outcomes Medicare B will not pay for immunosuppression
medications
what are some organ donor risk factors - ANSWER medical, social hx related to age of donor
condition of the organ
disease transmission ( human immunodeficiancy virus, hepatitis B, and hepatitis C, cancer,
malaria, disease not detectable at the time of transplant)
What is the standard immunosuppression used - ANSWER Prograf, cellcept, prednisione
Do the doctors remove native kidneys or pancreas? - ANSWER No, this allows the exocrine
function of the native pancreas to be preserved
what are the two surgical approaches to handle exocrine secretions produced by the
transplanted pancreas - ANSWER Enteric drainage (bowel drainage)
Bladder drainage
what happens when the surgeon does enteric drainage to manage exocrine secretions and
what is the benefit of the drainage - ANSWER About 2L of the enzymatic fluid and bicarbonate
produced by the pancreas is reabsorbed in the bowel
The donor portal vein is anastomosed to the side of the recipient's superior mesenteric vein,
the transplanted donor duodenal segment is attached to the recipient's jejunum to establish
exocrine drainage
Benefits of ED drainage: is that no fluid and electrolyte changes occur post-transplant due to its
similarity to the natural anatomy
what happens when the doctor does bladder drainage and what are the benefits - ANSWER This
directs venous outflow and insulin drainage into the iliac vein, exocrine drainage is via
anastomosis of a donor duodenal segment to the recipients urinary bladder
