Follow-Up of Patients After Total Pancreatectomy and Islet Cell Autotransplantation at Off-Site Islet Isolation Facility

Abstract

Objective Total pancreatectomy with islet autotransplantation (TPIAT) is a definitive management for intractable pain in patients with chronic pancreatitis. Islet autotransplantation (IAT) allows for the preservation of beta-cells to prevent complications of long-term diabetes. Our study follows TPIAT recipients for up to 12 years to determine the procedure’s efficacy completed with an off-site islet isolation facility. Methods Patient demographics, mixed meal tolerance test measures, glycosylated hemoglobin, insulin requirements, and homeostatic model assessment for insulin resistance values were collected prior to surgery and at the most recent follow-up. Results Forty-four patients (median age, 46.0 years; range, 20–78 years) underwent TPIAT for CP. At an overall median follow-up time of 845.5 days (range, 195–4470 days) 8 patients were insulin independent and 36 patients were insulin dependent. At the most recent follow-up, islet yield per kilogram was the strongest indicator of insulin independence. Homeostatic model assessment for insulin resistance values were comparable between insulin independent and dependent cohorts. Conclusions Our long-term follow-up data suggest that IAT can effectively reduce insulin requirements and improve post-operative glycemic control.

A static glucose-stimulated insulin secretion (sGSIS) assay that is significantly predictive of time to diabetes reversal in the human islet bioassay

“…Transplantation of autologous human islets is considered a therapeutic option for the palliative treatment of chronic pain in people undergoing total pancreatectomy 44 45. Transplantation of human islets obtained from allogeneic, cadaveric pancreata has shown remarkable impact in restoring metabolic control in people with brittle type 1 diabetes worldwide 46.…”

Current status of total pancreatectomy with islet autotransplantation for chronic and recurrent acute pancreatitis

“…However, several studies have shown that patients who have achieved insulin independence have been transplanted with a high proportion of islets. 30,32,37,53 As mentioned in the previous text, the islet isolation step is, therefore, an extremely critical step and should be performed with a skillful technique. The other associated factors include CP duration, 66 smoking, 32 and preoperative diabetes.…”

“…Next, the explanted pancreas is returned to the original center for infusion into the patient 51 . Although CIT may worsen the transplantation outcomes with this procedure, remote TPAIT does not worsen islet isolation outcomes, insulin independence rate, and glycemic control 52,53 . Therefore, if a system for transporting the pancreas is developed, remote isolation can be conducted at centers without isolation facilities to facilitate TPAIT.…”

“…There are various reports on the factors contributing to good graft function (e.g., insulin independence rate) after TPAIT. However, several studies have shown that patients who have achieved insulin independence have been transplanted with a high proportion of islets 30,32,37,53 . As mentioned in the previous text, the islet isolation step is, therefore, an extremely critical step and should be performed with a skillful technique.…”