Autotransplantation of culture-positive islet product: is dirty always bad?

Johnson, Crystal; Morgan, Katherine A.; Owczarski, Stefanie M.; Wang, Hongjun; Fried, June; Adams, David B.

doi:10.1111/hpb.12198

Cited by 24 publications

(14 citation statements)

References 19 publications

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“…Fat-soluble vitamins are provided as a water-miscible product. Bacterial contamination of the pancreas or islet product is common; it is treated with antibiotics, but conveys no adverse long-term risk when treated appropriately [31, 32]. Children are managed by a multidisciplinary team on a ward with nurses experienced in the post-operative management of TPIAT.…”

Section: Early Postoperative Carementioning

confidence: 99%

Pediatric Autologous Islet Transplantation

et al. 2015

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A total pancreatectomy and islet autotransplant (TPIAT) offers substantial pain relief and improved quality of life for children who are severely affected by chronic or recurrent acute pancreatitis and for whom the usual medical and endoscopic therapies have failed. The pancreas is entirely resected, and the pancreatic islets are isolated from the pancreas and infused back into the patient’s liver. Because this is an autologous transplant, no immunosuppression is required. Over several months, the islets engraft in the liver; the patient is then slowly weaned off insulin therapy. Slightly more than 40 % of patients become and remain insulin independent, yet even among patients who remain on insulin, most have some islet function, permitting easier diabetes control. The majority of patients experience pain relief, with significant improvements in health-related quality of life. A TPIAT should be considered for children who are significantly disabled by chronic pancreatitis.

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Section: Early Postoperative Carementioning

confidence: 99%

Pediatric Autologous Islet Transplantation

et al. 2015

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“…However, in a subset of patients, bacterial contamination remains even after this protocol. Although studies are limited, current data suggest that patients with bacterial contamination infrequently develop culture‐concordant infections and this contamination should not preclude transplantation . The impact of persistent bacterial contamination on graft success is unknown, and the purpose of this study was to determine whether bacterial contamination of the final islet preparation affects rates of insulin independence.…”

Section: Introductionmentioning

confidence: 99%

The impact of bacterial colonization on graft success after total pancreatectomy with autologous islet transplantation: considerations for early definitive surgical intervention

Jolissaint

Langman

DeBolt

et al. 2016

Clinical Transplantation

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Objective The purpose of this study was to determine whether bacterial contamination of islets affects graft success after total pancreatectomy with islet autotransplantation (TPIAT). Background Factors associated with insulin independence after TPIAT are inconclusive. Although bacterial contamination does not preclude transplantation, the impact of bacterial contamination on graft success is unknown. Methods Patients who received TPIAT at the University of Virginia between January 2007 and January 2016 were reviewed. Patient charts were reviewed for bacterial contamination and patients were prospectively contacted to assess rates of insulin-independence. Results There was no significant difference in demographic or perioperative data between patients who achieved insulin-independence and those who did not. However, six of 27 patients analyzed (22.2%) grew bacterial contaminants from culture of the final islet preparations. These patients had significantly lower islet yield and C-peptide at most recent follow-up (p<0.05), and none of these patients achieved insulin-independence. Conclusions Islet transplant solutions are often culture-positive, likely secondary to pre-procurement pancreatic manipulation and introduction of enteric flora. Although autotransplantation of culture-positive islets is safe, it is associated with higher rates of graft failure and poor islet yield. Consideration should be given to identify patients who may develop refractory chronic pancreatitis and offer early operative management to prevent bacterial colonization.

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“…According to most authors, positive cultures do not influence the outcome in patients following TPAIT (including postoperative infectious complications and islet cell viability). In cases of positive cultures, prophylactic antibiotic therapy is generally recommended [ 66 , 67 , 68 , 69 , 70 ]. Colling et al [ 68 ] analyzed retrospectively the sterility cultures from both the pancreas preservation solution used to transport the pancreas and the final islet preparation for intraportal infusion of patients undergoing TPAIT between April 2006 and November 2012.…”

Section: Pancreatic Islet Isolation and Transplantation—technical Aspectsmentioning

confidence: 99%

Total Pancreatectomy with Autologous Islet Cell Transplantation—The Current Indications

Jabłońska

Mrowiec

2021

JCM

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Total pancreatectomy is a major complex surgical procedure involving removal of the whole pancreatic parenchyma and duodenum. It leads to lifelong pancreatic exocrine and endocrine insufficiency. The control of surgery-induced diabetes (type 3) requires insulin therapy. Total pancreatectomy with autologous islet transplantation (TPAIT) is performed in order to prevent postoperative diabetes and its serious complications. It is very important whether it is safe and beneficial for patients in terms of postoperative morbidity and mortality, and long-term results including quality of life. Small duct painful chronic pancreatitis (CP) is a primary indication for TPAIT, but currently the indications for this procedure have been extended. They also include hereditary/genetic pancreatitis (HGP), as well as less frequent indications such as benign/borderline pancreatic tumors (intraductal papillary neoplasms, neuroendocrine neoplasms) and “high-risk pancreatic stump”. The use of TPAIT in malignant pancreatic and peripancreatic neoplasms has been reported in the worldwide literature but currently is not a standard but rather a controversial management in these patients. In this review, history, technique, indications, and contraindications, as well as short-term and long-term results of TPAIT, including pediatric patients, are described.

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Autotransplantation of culture-positive islet product: is dirty always bad?

Abstract: Islet transplant solutions are frequently culture-positive, presumably as a result of prior pancreas intervention. Microbial contamination of islet preparations should not preclude autotransplantation.

Cited by 24 publications

References 19 publications

Pediatric Autologous Islet Transplantation

Pediatric Autologous Islet Transplantation

The impact of bacterial colonization on graft success after total pancreatectomy with autologous islet transplantation: considerations for early definitive surgical intervention

Total Pancreatectomy with Autologous Islet Cell Transplantation—The Current Indications

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