Extending Indications for Islet Autotransplantation in Pancreatic Surgery

Balzano, Gianpaolo; Maffi, Paola; Nano, Rita; Zerbi, Alessandro; Venturini, Massimo; Melzi, Raffaella; Mercalli, Alessia; Magistretti, P.; Scavini, Marina; Castoldi, R.; Carvello, Michele; Braga, Marco; Maschio, Alessandro Del; Secchi, Antonio; Staudacher, C.; Piemonti, Lorenzo

doi:10.1097/sla.0b013e31829c790d

Cited by 65 publications

(55 citation statements)

References 37 publications

(44 reference statements)

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“…Islet auto-transplantation represents a more recent indication to prevent diabetes in case of extended pancreatectomy with better clinical outcome than allo-transplantation because of lack of immunosuppression [33]. In both cases, ␤-cells, infused through the portal vein, engraft at the level of the hepatic sinusoids [34].…”

Section: Discussionmentioning

confidence: 99%

Hepatic steatosis after islet transplantation: Can ultrasound predict the clinical outcome? A longitudinal study in 108 patients

Venturini

Maffi

Querques

et al. 2015

Pharmacological Research

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Section: Discussionmentioning

confidence: 99%

Hepatic steatosis after islet transplantation: Can ultrasound predict the clinical outcome? A longitudinal study in 108 patients

Venturini

Maffi

Querques

et al. 2015

Pharmacological Research

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“…the aforementioned reported series confirm this goal, with all 4 of the postdischarge deaths resulting from metastatic disease at 3 months to 3 years postsurgery. 8 We believe that TPIAT is an appropriate option for well-defined patients with chronic pancreatitis, leading to good outcomes. The key to using this technique for a broader cohort of patients is in a thoughtful consideration of the risk-benefit balance for any considered population.…”

Section: Indications For Tpiat (Must Have Each Of the Following 1-5)mentioning

confidence: 99%

“…7 These tumors are either new primaries or local recurrences (suggesting that even negative margins cannot predict removal of all disease), both of which create a concern for the use of islet preparation contaminated with ductal cells in patients with malignancy. Interestingly, in the series by Gianpaolo Balzano et al, 8 published in this issue of Annals of Surgery, none of the cancer recurrences were in the location of islet infusion. It is also difficult to ascertain a timeline beyond which a patient can be considered free of tumor if no recurrence is observed.…”

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confidence: 94%

Total Pancreatectomy With Islet Autotransplantation in Patients With Malignancy

2013

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Total pancreatectomy with islet autotransplantation (TPIAT) was first performed at the University of Minnesota in 1977 and has significantly improved options for the treatment of chronic pancreatitis, especially in patients with small duct disease. 1 Total pancreatectomy alone in chronic pancreatitis results in significant improvement in pain but is associated with brittle diabetes mellitus. This problem is significantly ameliorated with autotransplantation of islets isolated from the patient's pancreas using enzymatic techniques. Thus, TPIAT allows for complete surgical removal of the diseased pancreas with reduced consequences of loss of islet cell mass. The experience with TPIAT has grown at the University of Minnesota, and TPIAT has been performed in more than 500 cases since 1977. Interim experience with 409 patients was published in 2012, 2 with results demonstrating significant durable relief of pain and excellent diabetes control with improved quality of life. Our experience suggests that TPIAT is a very beneficial procedure with excellent outcomes if performed in an appropriate patient population. Given the difficulty in early diagnosis of chronic pancreatitis and heterogeneity of the population of patients with chronic pancreatitis, defining the appropriate population is sometimes difficult, leading us to develop clear, protocol-driven application of TPIAT. We strongly believe that all patients with chronic pancreatitis, who are being considered for TPIAT, benefit from discussion in a multidisciplinary forum consisting of surgeons, gastroenterologists, pain specialist, clinical psychologist, and endocrinologists and only patients who strictly meet the criteria for surgery should be considered for this procedure (Table 1). 3 Pancreatic malignancy or concern for malignancy remains a clear exclusion criterion at our center. Patients with malignancy involving the gland or diffuse intrapancreatic mucinous neoplasm are not considered for TPIAT. To date, we are unaware of disseminated pancreatic malignancy developing in any of the more than 500 patients in our robust experience. However, the concern regarding inadvertent infusion of malignant ductal cells is real, given that the isolation process enriches islets but does not totally eliminate ductal cells. The content of ductal cells (the hypothesized cell of origin for pancreatic ductal adenocarcinoma) in the islet preparation varies but is still significant even under the best isolation conditions. 4 Multifocality has been described in pancreatic cancer. 5,6 Furthermore, a field defect phenomenon is certainly a part of the disease process in intrapancreatic mucinous neoplasm. Although pancreatic cancer recurs most commonly as distant metastasis, it recurs solely in the pancreatic resection bed in about a quarter of patients. 7 These tumors are either new primaries or local recurrences (suggesting that even negative margins cannot predict removal of all disease), both of which create a concern for the use of islet preparation contaminated with ductal cells in...

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“…11,12 The percentage of patients undergoing pancreatectomy that develop pancreatogenic diabetes is 8-23% increasing up to 40-50% during the follow-up; 13,14 pancreatogenic diabetes can be prevented by percutaneous intraportal islet autotransplantation (PIPIAT), which is performed 12-48 h after surgery, does not require immunosuppression and has a lower rejection rate than allotransplantation. 15 The technical procedure of autotransplantation, as in allotransplantation, consists in isolation, centrifugation and percutaneous intraportal infusion of pancreatic islets, performed using a combined ultrasonographic and fluoroscopic guidance, 16 to reduce periprocedural complications. The aim of our study was to evaluate the feasibility, radiological aspects, complications and clinical outcome of PIPIAT after pancreatic surgery in patients affected by chronic pancreatitis or benign or malignant tumours.…”

Section: Introductionmentioning

confidence: 99%

Single-centre experience of extending indications for percutaneous intraportal islet autotransplantation (PIPIAT) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome

Venturini

Sallemi

Colantoni

et al. 2016

BJR

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Extending Indications for Islet Autotransplantation in Pancreatic Surgery

Abstract: Although larger data are needed to definitely exclude the risk of disease dissemination, the present study suggests that IAT indications can be extended to selected patients with neoplasm.

Cited by 65 publications

References 37 publications

Hepatic steatosis after islet transplantation: Can ultrasound predict the clinical outcome? A longitudinal study in 108 patients

Hepatic steatosis after islet transplantation: Can ultrasound predict the clinical outcome? A longitudinal study in 108 patients

Total Pancreatectomy With Islet Autotransplantation in Patients With Malignancy

Single-centre experience of extending indications for percutaneous intraportal islet autotransplantation (PIPIAT) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome

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