Anticoagulation practices in total pancreatectomy with autologous islet cell transplant patients: an international survey of clinical programs

Desai, Chirag S.; Szempruch, Kristen R.; Vonderau, Jennifer S.; Chetboun, Mikaël; Pattou, François; Coates, Toby; Paep, Diedert Luc De; Hawthorne, Wayne J.; Khan, Khalid; Koning, Eelco J.P. de; Naziruddin, Bashoo; Posselt, Andrew M.; Schrope, Beth; Wijkstrom, Martin; Witkowski, Piotr; Shapiro, A. M. James

doi:10.1111/tri.13821

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…However, two patients in the cohort did experience bleeding and required reoperation for hemorrhage control; thus, the risk of thrombosis must be balanced with the risk of bleeding. This bleeding risk is comparable to an approximate 6% bleeding risk in other cohorts [ 8 ].…”

Section: Discussionsupporting

confidence: 68%

“…This vulnerable time period is critical for patients, as hypotension, derangements in glucose, anemia, and hypoxia can cause loss of islet function [ 4 , 6 ]. Patients are also at particular risk for both bleeding and thrombosis, given heparin protocols and increases in portal venous pressure [ 7 , 8 ]. Thus, close monitoring and a multidisciplinary approach are necessary.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Management of Patients Undergoing Total Pancreatectomy with/without Islet Cell Autotransplantation: A Single Center Experience

Reid

Madduri

Agala

et al. 2023

JCM

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Total pancreatectomy (TP) and islet cell autotransplantation (IAT) are complex operations that require intensive postoperative monitoring with standardized protocols. There are few studies detailing immediate perioperative management. The purpose of this study was to describe the perioperative management of post-pancreatectomy patients in the first week following surgery to guide clinicians in addressing salient points from different organ systems. This is a retrospective cohort review of prospectively collected data from September 2017 to September 2022 at a single institution, including patients 16 years and older who underwent TP or TPIAT for chronic pancreatitis. Patients were maintained on a heparin drip (TPIAT), insulin drip, and ketamine infusion. Primary outcomes were complications in the first 5 days following surgery and ICU length of stay (LOS). Secondary outcomes included overall LOS and mortality. Of 31 patients, 26 underwent TPIAT, and 5 underwent TP. Median ICU LOS was five days (IQR 4–6). The most common immediate postoperative complications were reintubation [n = 5 (16%)] and bleeding [n = 2 (6%)]. Median insulin drip use was 70 h (IQR 20–124). There was no mortality. Patients were extubated quickly and progressed well on the protocol. Immediate postoperative complications were generally minor and without long-term effects.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Perioperative Management of Patients Undergoing Total Pancreatectomy with/without Islet Cell Autotransplantation: A Single Center Experience

Reid

Madduri

Agala

et al. 2023

JCM

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“…Heparin (5000 IU) was added to the islet preparation, immediately postoperatively patients were started on a continuous intravenous heparin drip, monitored and adjusted according to activated partial thromboplastin time (PTT; range of 40-50 s) for at least 48 h and thereafter switched to subcutaneous low molecular weight heparin until discharge. Target PTT was discussed with the surgeons and adjusted where appropriate 15 .…”

Section: Methodsmentioning

confidence: 99%

Quality of life and metabolic outcomes after total pancreatectomy and simultaneous islet autotransplantation

et al. 2022

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Background Pancreas surgery remains technically challenging and is associated with considerable morbidity and mortality. Identification of predictive risk factors for complications have led to a stratified surgical approach and postoperative management. The option of simultaneous islet autotransplantation (sIAT) allows for significant attenuation of long-term metabolic and overall complications and improvement of quality of life (QoL). The potential of sIAT to stratify a priori the indication for total pancreatectomy is yet not adequately evaluated. Methods The aim of this analysis was to evaluate the potential of sIAT in patients undergoing total pancreatectomy to improve QoL, functional and overall outcome and therefore modify the surgical strategy towards earlier and extended indications. A center cohort of 24 patients undergoing pancreatectomy were simultaneously treated with IAT. Patients were retrospectively analyzed regarding in-hospital and overall mortality, postoperative complications, ICU stay, hospital stay, metabolic outcome, and QoL. Results Here we present that all patients undergoing primary total pancreatectomy or surviving complicated two-stage pancreas resection and receiving sIAT show excellent metabolic outcome (33% insulin independence, 66% partial graft function; HbA1c 6,1 ± 1,0%) and significant benefit regarding QoL. Primary total pancreatectomy leads to significantly improved overall outcome and a significant reduction in ICU- and hospital stay compared to a two-stage completion pancreatectomy approach. Conclusions The findings emphasize the importance of risk-stratified pancreas surgery. Feasibility of sIAT should govern the indication for primary total pancreatectomy particularly in high-risk patients. In rescue completion pancreatectomy sIAT should be performed whenever possible due to tremendous metabolic benefit and associated QoL.

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“…Desai et al show high variability of practice but some generalizations regarding the concern for hypercoagulable status, use of unfractionated heparin intraoperatively and use of anticoagulation with low molecular weight heparin in the postoperative period. Practices of anticoagulation have been inconsistent and protocols will need to be unified [ 39 ].…”

Section: Advances In Managementmentioning

confidence: 99%

What Is New with Total Pancreatectomy and Autologous Islet Cell Transplantation? Review of Current Progress in the Field

Baldwin

Williams

Schrope

et al. 2021

JCM

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Patients with chronic pancreatitis have benefited from total pancreatectomy and autologous islet cell transplantation (TPAIT) since the 1970s. Over the past few decades, improvements have been made in surgical technique and perioperative management that have led to improved success of islet cell function, insulin independence and patient survival. This article focuses on recent updates and advances for the TPAIT procedure that continue to expand and innovate the impact on patients with debilitating disease.

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Anticoagulation practices in total pancreatectomy with autologous islet cell transplant patients: an international survey of clinical programs

Cited by 5 publications

References 7 publications

Perioperative Management of Patients Undergoing Total Pancreatectomy with/without Islet Cell Autotransplantation: A Single Center Experience

Perioperative Management of Patients Undergoing Total Pancreatectomy with/without Islet Cell Autotransplantation: A Single Center Experience

Quality of life and metabolic outcomes after total pancreatectomy and simultaneous islet autotransplantation

What Is New with Total Pancreatectomy and Autologous Islet Cell Transplantation? Review of Current Progress in the Field

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