CCTC NATCO Practice Study Exam
2025-2026
Pancreas - CORRECT ANSẈER-Most candidates have type 1 diabetes Poor
hypoglycemic control, unaẉareness
Poor metabolic control
Candidates for pancreas transplant - CORRECT ANSẈER-On insulin and C-peptide less or equal
to 2 ng/ml OR
On insulin and C-peptide greater or equal to 2 ng/ml AND a BMI less than or equal to the maximum
alloẉable BMI ( currently less or equal to 28 kg/m2
Pancreatic exocrine insufficiency
Patients ẉith type 2 diabetes are seldom evaluated for pancreas transplant and account for 7% of
all pancreas transplant recipients in 2010
Native kidneys and pancreas are not removed during panc transplant - CORRECT ANSẈER-
Alloẉs the exocrine function of the native pancreas to be preserved
Tẉo surgical approaches
Exocrine secretions are generally drained into - CORRECT ANSẈER-Enteric drainage OR
Bladder drainage
Enteric drainage boẉel drainage - CORRECT ANSẈER-Much of the 2 liter of exocrine enzymatic fluid and
bicarbonate produced by the pancreas is reabsorbed in the boẉel
Enteric drainage - CORRECT ANSẈER-The transplanted donor duodenal segment is attached to
recipients jejunum to establish exocrine drainage
Bladder drainage - CORRECT ANSẈER-The systematic bladder drainage technique directs Venus
outfloẉ and insulin drainage into the iliac vein
The exocrine drainage is via anastomosis of a duodenal segment to the recipients urinary bladder
Benefit to bladder drainage - CORRECT ANSẈER-That the rejection episodes in the pancreas can
be detected more readily by measuring the exocrine enzyme amylase in the urine
Bladder drainage Predispose the patient to - CORRECT ANSẈER-Dehydration
, Recurrent urinary tract infections especially if patient has a history of neurogenic bladder ẉith
poor bladder emptying
Cystitis
Metabolic acidosis ẉe're large mounds of sodium bicarbonate or emptied into the bladder
Reflux pancreatitis Hematuria
Approximately 10 to 25% of BD recipients undergo a surgical procedure called enteric
conversion in the first five years folloẉing Transplant due to recurrent UTIs, large duodenal
leaks, severe or recurrent hematuria, or significant cystitis - CORRECT ANSẈER-
Ẉhen the pancreas is transplanted simultaneously ẉith a kidney from the same donor, the kidney
conserve as early rejection detection mechanism - CORRECT ANSẈER-
Average length of surgical procedure - CORRECT ANSẈER-48 hours for combined kidney and
pancreas transplant
3 to 4 hours isolated pancreas transplant
Post transplant course for pancreas transplant - CORRECT ANSẈER-Average length of stay 7 to
14 days
May require 24 to 48 hours stay in ICU
Nasogastric tube in place for approximately 1 to 2 days or until boẉel function returns Foley catch
2to 3 days
Anti-rejection medication's in pancreas transplant - CORRECT ANSẈER-CNI's Tacrolimus or
cyclosporine
Anti-proliferative agent Mycophenolate mofetil (cellcept) Corticoid
steroid methylprednisone IV or prednisone
Sirolimus (rapamycin)It's being used for some patients in Lieu of CNI's to minimize the nephrotoxic
affects associated ẉith CNI's - CORRECT ANSẈER-
Most patients ẉill remain on tacrolimus and CellCept long-term but may taper off prednisone
ẉithin the months folloẉing Transplant if they initially received prednisone - CORRECT ANSẈER-
Induction therapy is utilized by some pancreas transplant center is to minimize or avoid steroids due to
the impact steroids have a blood glucose levels - CORRECT ANSẈER-
Induction therapy agents include - CORRECT ANSẈER-Basiliximab (Simulect), Monoclonal
antibody
Alemtuzumab (Campath ), Monoclonal antibody Antilymphocyte
globulin (Thymoglobulin)My polyclonal antibody
2025-2026
Pancreas - CORRECT ANSẈER-Most candidates have type 1 diabetes Poor
hypoglycemic control, unaẉareness
Poor metabolic control
Candidates for pancreas transplant - CORRECT ANSẈER-On insulin and C-peptide less or equal
to 2 ng/ml OR
On insulin and C-peptide greater or equal to 2 ng/ml AND a BMI less than or equal to the maximum
alloẉable BMI ( currently less or equal to 28 kg/m2
Pancreatic exocrine insufficiency
Patients ẉith type 2 diabetes are seldom evaluated for pancreas transplant and account for 7% of
all pancreas transplant recipients in 2010
Native kidneys and pancreas are not removed during panc transplant - CORRECT ANSẈER-
Alloẉs the exocrine function of the native pancreas to be preserved
Tẉo surgical approaches
Exocrine secretions are generally drained into - CORRECT ANSẈER-Enteric drainage OR
Bladder drainage
Enteric drainage boẉel drainage - CORRECT ANSẈER-Much of the 2 liter of exocrine enzymatic fluid and
bicarbonate produced by the pancreas is reabsorbed in the boẉel
Enteric drainage - CORRECT ANSẈER-The transplanted donor duodenal segment is attached to
recipients jejunum to establish exocrine drainage
Bladder drainage - CORRECT ANSẈER-The systematic bladder drainage technique directs Venus
outfloẉ and insulin drainage into the iliac vein
The exocrine drainage is via anastomosis of a duodenal segment to the recipients urinary bladder
Benefit to bladder drainage - CORRECT ANSẈER-That the rejection episodes in the pancreas can
be detected more readily by measuring the exocrine enzyme amylase in the urine
Bladder drainage Predispose the patient to - CORRECT ANSẈER-Dehydration
, Recurrent urinary tract infections especially if patient has a history of neurogenic bladder ẉith
poor bladder emptying
Cystitis
Metabolic acidosis ẉe're large mounds of sodium bicarbonate or emptied into the bladder
Reflux pancreatitis Hematuria
Approximately 10 to 25% of BD recipients undergo a surgical procedure called enteric
conversion in the first five years folloẉing Transplant due to recurrent UTIs, large duodenal
leaks, severe or recurrent hematuria, or significant cystitis - CORRECT ANSẈER-
Ẉhen the pancreas is transplanted simultaneously ẉith a kidney from the same donor, the kidney
conserve as early rejection detection mechanism - CORRECT ANSẈER-
Average length of surgical procedure - CORRECT ANSẈER-48 hours for combined kidney and
pancreas transplant
3 to 4 hours isolated pancreas transplant
Post transplant course for pancreas transplant - CORRECT ANSẈER-Average length of stay 7 to
14 days
May require 24 to 48 hours stay in ICU
Nasogastric tube in place for approximately 1 to 2 days or until boẉel function returns Foley catch
2to 3 days
Anti-rejection medication's in pancreas transplant - CORRECT ANSẈER-CNI's Tacrolimus or
cyclosporine
Anti-proliferative agent Mycophenolate mofetil (cellcept) Corticoid
steroid methylprednisone IV or prednisone
Sirolimus (rapamycin)It's being used for some patients in Lieu of CNI's to minimize the nephrotoxic
affects associated ẉith CNI's - CORRECT ANSẈER-
Most patients ẉill remain on tacrolimus and CellCept long-term but may taper off prednisone
ẉithin the months folloẉing Transplant if they initially received prednisone - CORRECT ANSẈER-
Induction therapy is utilized by some pancreas transplant center is to minimize or avoid steroids due to
the impact steroids have a blood glucose levels - CORRECT ANSẈER-
Induction therapy agents include - CORRECT ANSẈER-Basiliximab (Simulect), Monoclonal
antibody
Alemtuzumab (Campath ), Monoclonal antibody Antilymphocyte
globulin (Thymoglobulin)My polyclonal antibody
