Total pancreatectomy and islet autotransplantation: A decade nationwide analysis

Fazlalizadeh, Reza; Moghadamyeghaneh, Zhobin; Demirjian, Aram N.; Imagawa, David K.; Foster, Clarence E.; Lakey, Jonathan R.T.; Stamos, Michael J.; Ichii, Hirohito

doi:10.5500/wjt.v6.i1.233

Cited by 16 publications

(8 citation statements)

References 36 publications

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“…Indeed, the trends proposed from our small cohort welcome larger analyses in patients of diverse etiology and in a larger context. Although other clinical trials have also found the majority of study participants were similar in age, gender, and ethnicity to ours, 11 , 31 our patient cohort demonstrates that wide variability exists in islet status irrespective of putative patient similarity. However, this cohort does not represent the population at large and caution should be applied to any broad extrapolation.…”

Section: Discussionsupporting

confidence: 61%

“…The progressive inflammation and associated fibrosis in CP has been shown to cause endocrine insufficiency and eventual diabetes, with significant islet damage. 9 Indeed, although it is logical and expected that insufficient transplanted islet mass has poorer glycemic outcomes, 10 , 11 achieving or even surpassing suggested transplanted islet number alone is still inadequate to guarantee insulin independence, and the role and methods of defining pretransplant islet function are critically required. We recently showed that CP itself contributes to islet identity loss 12 and is an independent variable from the clinical guideline of transplanting ≥5000 islet equivalents (IE) per kilogram body weight.…”

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confidence: 99%

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Pretransplant HOMA-β Is Predictive of Insulin Independence in 7 Patients With Chronic Pancreatitis Undergoing Islet Autotransplantation

Beamish

Gaber

Fraga

et al. 2022

Transplantation Direct

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Background. Islet and β-cell function is intrinsic to glucose homeostasis. Pancreatectomy and islet autotransplantation (PIAT) for chronic pancreatitis (CP) treatment is a useful model for assessing islet function in the absence of immune-suppression and to perform extensive presurgical metabolic evaluations not possible from deceased donors. We recently showed that in CP-PIAT patients, preoperative islet identity loss presented with postoperative glycemic loss. Here, we examine presurgical islet function using Homeostatic Model Assessment-Beta Cell Function (%) (HOMA-β) and glycemic variables and compared them with postsurgical insulin independence and their predicted alignment with Secretory Unit of Islet Transplant Objects (SUITO) and beta cell score after transplantation (BETA-2) scores. Methods. Seven CP-PIAT patients were assessed for β-cell function metrics, including pretransplant and 6-mo posttransplant HOMA-β using insulin and C-peptide and evaluations of proposed insulin independence by SUITO and BETA-2 graft function equations. These were compared with oral glucose tolerance tests and pancreas histological samples taken at the time of transplant, examined for β-cell maturity markers. Results. Pre-PIAT, HOMA-β (60%−100%) associated with post-PIAT insulin independence. This association was only moderately supported by post-PIAT SUITO threshold scores (≥26) but robustly by BETA-2 scores (≥16.2). Appropriate posttransplant oral glucose tolerance test curves were found in those patients with normal pretransplant HOMA-β values. Preoperative low serological β-cell function was displayed by concurrent evidence of β-cell identity alterations including colocalization of insulin and glucagon, loss of urocortin-3, and increased intra-islet vimentin in patients who were insulin-dependent post-PIAT. Conclusions. These data encourage HOMA-β assessment before PIAT for estimating posttransplant insulin independence.

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Section: Discussionsupporting

confidence: 61%

mentioning

confidence: 99%

Pretransplant HOMA-β Is Predictive of Insulin Independence in 7 Patients With Chronic Pancreatitis Undergoing Islet Autotransplantation

Beamish

Gaber

Fraga

et al. 2022

Transplantation Direct

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“…The concept behind this approach is interesting, because the procedure seems to be safe and theoretically able to maintain good glycemic control, thus avoiding one of the devastating complications of TP [30]. The rate of insulin independence after auto-islet transplantation ranges between 24 and 40 % in the largest series as reported in Table 2 [28, 31–33].…”

Section: Indications For Total Pancreatectomymentioning

confidence: 99%

Are there still indications for total pancreatectomy?

et al. 2016

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Total pancreatectomy is associated with short- and long-term high complication rate and without evidence of oncologic advantages. Several metabolic consequences are co-related with the apancreatic state. The unstable diabetes related to the total resection of the pancreas expose the patients to short- and long-term life-threatening complications. Severe hypoglycemia is a short-term dangerous complication that can also cause patients’ death. Chronic complications of severe diabetes (cardiac and vascular diseases, neuropathy, nephropathy, and retinopathy) are also cause of morbidity, mortality and worsening of quality of life. For this reasons the number of total pancreatectomies performed has certainly decreased over time. However, today there are still some indications for this kind of procedures. Chronic pancreatitis untreatable with conventional treatments, surgical treatment of precancerous pancreatic lesions, surgical treatment of locally advanced pancreatic cancer and the management of patients with extraordinary high-risk pancreatic texture after pancreaticoduodenectomy represent possible indications for total pancreatectomy and are analyzed in the present paper.

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“…QoL metrics show TPIAT as equal or superior to traditional TPs[ 24 - 27 ]. Morbidity and mortality metrics also support TPIAT as a safe and feasible procedure[ 28 ]. However, over this same time, minimal systematic evidence has been collected on metabolic function and pain control following TPIAT.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of total pancreatectomy with islet autotransplantation: A systematic review and meta-analysis

Khazaaleh¹,

Babar²,

Alomari³

et al. 2023

World J Transplant

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BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation (TPIAT), systematic evidence of its outcomes remains limited. AIM To evaluate the outcomes of TPIAT. METHODS We searched PubMed, EMBASE, and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes. Data were extracted and analyzed using comprehensive meta-analysis software. The random-effects model was used for all variables. Heterogeneity was assessed using the I 2 measure and Cochrane Q-statistic. Publication bias was assessed using Egger’s test. RESULTS Twenty-one studies published between 1980 and 2017 examining 1011 patients were included. Eighteen studies were of adults, while three studied pediatric populations. Narcotic independence was achieved in 53.5% [95% Confidence Interval (CI): 45-62, P < 0.05, I 2 = 81%] of adults compared to 51.9% (95%CI: 17-85, P < 0.05, I 2 = 84%) of children. Insulin-independence post-procedure was achieved in 31.8% (95%CI: 26-38, P < 0.05, I 2 = 64%) of adults with considerable heterogeneity compared to 47.7% (95%CI: 20-77, P < 0.05, I 2 = 82%) in children. Glycated hemoglobin (HbA 1C ) 12 mo post-surgery was reported in four studies with a pooled value of 6.76% ( P = 0.27). Neither stratification by age of the studied population nor meta-regression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies. CONCLUSION These results indicate acceptable success for TPIAT. Future studies should evaluate the discussed measures before and after surgery for comparison.

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Total pancreatectomy and islet autotransplantation: A decade nationwide analysis

Abstract: TP + IAT is a safe procedure with no mortality, acceptable morbidity, and achieved high rate of early insulin independence. Obesity is the most significant predictor of in-hospital morbidity.

Cited by 16 publications

References 36 publications

Pretransplant HOMA-β Is Predictive of Insulin Independence in 7 Patients With Chronic Pancreatitis Undergoing Islet Autotransplantation

Pretransplant HOMA-β Is Predictive of Insulin Independence in 7 Patients With Chronic Pancreatitis Undergoing Islet Autotransplantation

Are there still indications for total pancreatectomy?

Outcomes of total pancreatectomy with islet autotransplantation: A systematic review and meta-analysis

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