Total Pancreatectomy With Islet Autotransplantation

Bellin, Melena D.; Gelrud, Andrés; Arreaza-Rubín, Guillermo; Dunn, Ty B.; Humar, Abhinav; Morgan, Katherine A.; Naziruddin, Bashoo; Rastellini, Cristiana; Rickels, Michael R.; Schwarzenberg, Sarah Jane; Andersen, Dana K.

doi:10.1097/mpa.0000000000000236

Cited by 56 publications

(26 citation statements)

References 67 publications

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“…These findings build upon previously reports of relationship between MRI findings and islet yield [9], are clinically applicable to counseling the TPIAT recipient, and address an important research gap recently identified by experts in the field of TPIAT, to better define markers for diabetes risk after TPIAT [18]. Calcifications in particular increased the odds of insulin dependence greatly—those with parenchymal calcifications were at 4 fold greater risk of remaining insulin dependent at 1 year after the surgery compared to those without.…”

Section: Discussionsupporting

confidence: 73%

Preoperative Computerized Tomography and Magnetic Resonance Imaging of the Pancreas Predicts Pancreatic Mass and Functional Outcomes After Total Pancreatectomy and Islet Autotransplant

et al. 2016

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Objectives About two-thirds of patients will remain on insulin therapy after total pancreatectomy with islet autotransplant (TPIAT) for chronic pancreatitis. We investigated the relationship between measured pancreas volume on computerized tomography (CT) or magnetic resonance imaging (MRI), and features of chronic pancreatiits on imaging, with subsequent islet isolation and diabetes outcomes. Methods CT or MRI was reviewed for pancreas volume (Vitrea software), and presence or absence of calcifications, atrophy, and dilated pancreatic duct in 97 patients undergoing TPIAT. Relationship between these features and: (1) islet mass isolated and (2) diabetes status at 1 year post-TPAIT were evaluated. Results Pancreas volume correlated with islet mass measured as total islet equivalents (r=0.50, p<0.0001). Mean islet equivalents was reduced by more than half if any one of calcifications, atrophy, or ductal dilatation were observed. Pancreatic calcifications increased the odds of insulin dependence 4.0 fold (1.1, 15). Collectively, the pancreas volume and 3 imaging features strongly associated with 1 year insulin use (p=0.07), islet graft failure (p=0.003), Hemoglobin A1c (p=0.0004), fasting glucose (p=0.027), and fasting C-peptide level (p=0.008). Conclusions Measures of pancreatic parenchymal destruction on imaging, including smaller pancreas volume and calcifications associate strongly with impaired islet mass and 1 year diabetes outcomes.

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Section: Discussionsupporting

confidence: 73%

Preoperative Computerized Tomography and Magnetic Resonance Imaging of the Pancreas Predicts Pancreatic Mass and Functional Outcomes After Total Pancreatectomy and Islet Autotransplant

et al. 2016

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“…For many years, TP with pancreatic transplantation has been conducted in patients with type 1 diabetes[ 119 ] and TP combined with islet autotransplantation has been performed on chronic pancreatitis patients with intractable pain[ 121 ]. However, most recently, due to the improvements in post-surgical quality of life, these treatment procedures have been considered and actually indicated for FPC kindred with premalignant lesions[ 119 , 122 , 123 ].…”

Section: Surveillance Of High Risk Individualsmentioning

confidence: 99%

Familial pancreatic cancer: Concept, management and issues

Matsubayashi

Takaori

Morizane

et al. 2017

WJG

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Familial pancreatic cancer (FPC) is broadly defined as two first-degree-relatives with pancreatic cancer (PC) and accounts for 4%-10% of PC. Several genetic syndromes, including Peutz-Jeghers syndrome, hereditary pancreatitis, hereditary breast-ovarian cancer syndrome (HBOC), Lynch syndrome, and familial adenomatous polyposis (FAP), also have increased risks of PC, but the narrowest definition of FPC excludes these known syndromes. When compared with other familial tumors, proven genetic alterations are limited to a small proportion (< 20%) and the familial aggregation is usually modest. However, an ethnic deviation (Ashkenazi Jewish > Caucasian) and a younger onset are common also in FPC. In European countries, “anticipation” is reported in FPC families, as with other hereditary syndromes; a trend toward younger age and worse prognosis is recognized in the late years. The resected pancreases of FPC kindred often show multiple pancreatic intraepithelial neoplasia (PanIN) foci, with various K-ras mutations, similar to colorectal polyposis seen in the FAP patients. As with HBOC patients, a patient who is a BRCA mutation carrier with unresectable pancreatic cancer (accounting for 0%-19% of FPC patients) demonstrated better outcome following platinum and Poly (ADP-ribose) polymerase inhibitor treatment. Western countries have established FPC registries since the 1990s and several surveillance projects for high-risk individuals are now ongoing to detect early PCs. Improvement in lifestyle habits, including non-smoking, is recommended for individuals at risk. In Japan, the FPC study group was initiated in 2013 and the Japanese FPC registry was established in 2014 by the Japan Pancreas Society.

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“…Reduction in pain and narcotic dependence after pancreatectomy, as well as maintenance of islet cell function after autotransplantation, have only been shown to be moderately successful, as well as age dependent, being more successful in younger patients. 100 , 101 Pancreatectomy with islet cell autotransplantation is an irreversible procedure with rare but serious risks and commits the patient to a lifetime of exogenous pancreatic enzyme replacement as well as a high likelihood of insulin dependence over time. Thus, extensive risk–benefit analysis by a multidisciplinary team, which is individualized to the patient, needs to be undertaken prior to the decision to pursue surgical resection.…”

Section: Treatmentmentioning

confidence: 99%

Hereditary pancreatitis: current perspectives

Raphael¹,

Willingham²

2016

CEG

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Hereditary pancreatitis (HP) is a rare cause of acute, recurrent acute, and chronic pancreatitis. It may present similarly to other causes of acute and chronic pancreatitis, and often there has been a protracted evaluation prior to the diagnosis of HP. Since it was first described in 1952, multiple genetic defects that affect the action of digestive enzymes in the pancreas have been implicated. The most common mutations involve the PRSS1, CFTR, SPINK1, and CTRC genes. New mutations in these genes and previously unrecognized mutations in other genes are being discovered due to the increasing use of next-generation genomic sequencing. While the inheritance pathways of these genetic mutations may be variable and complex, sometimes involving coinheritance of other mutations, the clinical presentation of patients tends to be similar. Interactions with environmental triggers often play a role. Patients tend to present at an early age (prior to the second decade of life) and have a significantly increased risk for the development of pancreatic adenocarcinoma. Patients with HP may develop sequelae of chronic pancreatitis such as strictures and fluid collections as well as exocrine and endocrine insufficiency. Management of patients with HP involves avoidance of environmental triggers, surveillance for pancreatic adenocarcinoma, medical therapy for endocrine and exocrine insufficiency, pain management, and endoscopic or surgical treatment for complications. Care for affected patients should be individualized, with an emphasis on early diagnosis and multidisciplinary involvement to develop a comprehensive treatment strategy.

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Total Pancreatectomy With Islet Autotransplantation

Cited by 56 publications

References 67 publications

Preoperative Computerized Tomography and Magnetic Resonance Imaging of the Pancreas Predicts Pancreatic Mass and Functional Outcomes After Total Pancreatectomy and Islet Autotransplant

Preoperative Computerized Tomography and Magnetic Resonance Imaging of the Pancreas Predicts Pancreatic Mass and Functional Outcomes After Total Pancreatectomy and Islet Autotransplant

Familial pancreatic cancer: Concept, management and issues

Hereditary pancreatitis: current perspectives

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