Total Pancreatectomy With Islet Autotransplantation

Abstract

A workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases focused on research gaps and opportunities in total pancreatectomy with islet autotransplantation (TPIAT) for the management of chronic pancreatitis. The session was held on July 23, 2014 and structured into 5 sessions: (1) patient selection, indications, and timing; (2) technical aspects of TPIAT; (3) improving success of islet autotransplantation; (4) improving outcomes after total pancreatectomy; and (5) registry considerations for TPIAT. The current state of knowledge was reviewed; knowledge gaps and research needs were specifically highlighted. Common themes included the need to identify which patients best benefit from and when to intervene with TPIAT, current limitations of the surgical procedure, diabetes remission and the potential for improvement, opportunities to better address pain remission, GI complications in this population, and unique features of children with chronic pancreatitis considered for TPIAT. The need for a multicenter patient registry that specifically addresses the complexities of chronic pancreatitis and total pancreatectomy outcomes and postsurgical diabetes outcomes was repeatedly emphasized.

Unmethylated Insulin DNA Is Elevated After Total Pancreatectomy With Islet Autotransplantation: Assessment of a Novel Beta Cell Marker

“…However, until recently, the islet transplant field has lacked biomarkers to detect beta cell loss (10, 11). Such markers may be critically important in addressing barriers to success in islet transplantation.…”

Autologous Islet Transplantation in Patients Requiring Pancreatectomy: A Broader Spectrum of Indications Beyond Chronic Pancreatitis

“…Pancreatogenic diabetes mellitus is a common complication of pancreatic surgery and is associated with hypoglycemic episodes and long‐term complications , the latter more likely to occur than in the past because of the longer life expectancy . Islet autotransplantation (IAT) is a valuable option to avoid or minimize postsurgery pancreatogenic diabetes . In the past, IAT has been performed almost exclusively in patients undergoing pancreatectomy because of chronic pancreatitis, successfully preserving β‐cell mass and preventing diabetes after major pancreatic resections .…”

Academic Pancreas Centers of Excellence: Guidance from a multidisciplinary chronic pancreatitis working group at PancreasFest

“…Discussion : Expert reviews and guidelines make recommendations on different aspects of care and follow up of patients [7–10,14–18]. Although natural history studies inform us of the presentation and course of chronic pancreatitis [19–22], providing information on the probability of outcome(s) tailored to individual patients is not currently possible.…”