Islet Autotransplant Outcomes After Total Pancreatectomy: A Contrast to Islet Allograft Outcomes

Abstract

Islet function is more resilient in autografts than allografts. Indeed, the 5-year insulin-independence persistence rate for IATs is similar to the 2-year rate for allografts. Several factors unique to allocases are likely responsible for the differences, including donor brain death, longer cold ischemia time, diabetogenic immunosuppression, and auto- and alloimmunity. IAT outcomes provide a minimum theoretical standard to work toward in allotransplantation.

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

“…There was significant heterogeneity between studies in terms of sex ratio and underlying cause of chronic pancreatitis ( Table 1). The majority of patients reviewed were from centres in the USA 13 . Two of the publications 11,13 were reported in such a way that insufficient demographic data could be extracted.…”

“…The majority of patients reviewed were from centres in the USA 13 . Two of the publications 11,13 were reported in such a way that insufficient demographic data could be extracted. Notably, the duration of chronic pancreatitis before treatment was not recorded in any of the included studies.…”

“…It has also been suggested that TP/IAT should be carried out early in the course of chronic pancreatitis, thus avoiding complications of chronic opioid use. Another advantage of early TP/IAT is the higher islet yield from a pancreatic parenchyma that is less compromised by fibrosis or previous surgery 13 . With the increasing success of TP/IAT, this procedure may be offered early in the course of the natural history of chronic pancreatitis.…”

“…As far as purification of islets was concerned, there was no agreed technique between studies. Sutherland and co-workers 13 reported that, since 2006, purification was performed when the tissue digest was over 20 cm 3 .…”

“…In the Cincinnati series, splenectomy was performed routinely, and TP was carried out with removal of the duodenum and distal bile duct with pylorus preservation 12 . In Minnesota the spleen was preserved only if it retained a normal appearance following hilar ligation 13 .…”