Omental Pouch Technique for Combined Site Islet Autotransplantation Following Total Pancreatectomy

Total pancreatectomy and islet autotransplantation (TPIAT) is an effective treatment for selected patients with chronic pancreatitis. The portal circulation is the standard infusion site for islet transplant, but marked elevation of portal pressures may prevent complete islet infusion. Herein we report a novel technique of combined site islet autotransplantation using an omental pouch. This technique may be useful when technical limitations prevent complete intraportal transplantation. In four TPIAT recipients with intraoperative issues precluding the complete intraportal infusion of islets, an omental pouch was created to contain the remaining islet mass. Patients were monitored for complications, and islet graft function was assessed using mixed meal tolerance testing and compared with matched controls who received only intraportally transplanted islets. All patients had decreasing insulin requirements as their recovery progressed. At 3 months follow-up there were no significant differences in glycemic control or graft function for the combined site recipients compared with their matched controls who only received an intraportal islet infusion. The omentum has potentially desirable qualities such as accessibility, capacity, and systemic/portal vascularity comparable to the native pancreas. The omental pouch technique may represent a safe and effective alternate site for islet autotransplantation. Further study is needed to confirm these findings.

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Increase in Postoperative Insulin Requirements Does Not Lead to Decreased Quality of Life after Total Pancreatectomy with Islet Cell Autotransplantation for Chronic Pancreatitis

The American Surgeon ◽

10.1177/000313481307900710 ◽

2013 ◽

Vol 79 (7) ◽

pp. 676-680 ◽

Cited By ~ 8

Author(s):

Margaret Dorlon ◽

Stephanie Owczarski ◽

Hongjun Wang ◽

David Adams ◽

Katherine Morgan

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Chronic Pancreatitis ◽

Islet Cell ◽

Total Pancreatectomy ◽

Daily Insulin ◽

Insulin Requirements ◽

Islet Autotransplantation ◽

Component Scores

Previous studies have shown that total pancreatectomy with islet cell autotransplantation improves quality of life in chronic pancreatitis. A significant number of these patients develop postoperative hyperglycemia and daily insulin requirements or increase in daily insulin requirements. Our study investigates whether increased insulin requirements postoperatively have a negative impact on quality of life. A prospectively collected database of 74 patients undergoing extensive pancreatectomy with islet autotransplantation for pancreatitis was reviewed. Data pertaining to daily requirements and quality of life (QOL), as measured by the SF-12 questionnaire, in the preoperative and postoperative period were reviewed. Approval from the Institutional Review Board for the evaluation of human subjects was obtained. Seventy-four patients underwent extensive pancreatectomy with islet autotransplantation for pancreatitis. The majority of these patients required new daily insulin or an increase in daily insulin requirements post-operatively. Mean preoperative HA1c in this group was 5.6 with an increase to 7.3 at 6 months postoperatively ( P < 0.001), a mean of 8.1 at 12 months, and 8.9 at 2 years. Mean preoperative daily insulin requirements for this group were five units/day with average increase to 19 units/day at 6 months, 21 units/day at 12 months, and 26 units/day at 2 years. Preoperative QOL scores were a mean of 26 for the physical component and 36 for the mental health component. Postoperatively, physical component scores averaged 33 at 6 months (p < 0.001), 36 at 12 months, and 36 at 2 years; the mental health component scores averaged 42 at 6 months (p = 0.007), 41 at 12 months, and 41 at 2 years. There is no correlation between physical component score or mental component score QOL scores and daily insulin requirements ( r = -0.016 and r = 0.039, respectively). Total pancreatectomy with islet cell autotransplantation is an effective surgery for end-stage chronic pancreatitis. Quality of life significantly improves in physical and mental health components regardless of a postoperative increase in daily insulin requirements.

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Long-term Stability of β-Cell Graft Function After Total Pancreatectomy and Islet Autotransplantation

Pancreas ◽

10.1097/mpa.0000000000001711 ◽

2021 ◽

Vol 50 (1) ◽

pp. e2-e4

Author(s):

Piotr J. Bachul ◽

Karolina Golab ◽

Lindsay Basto ◽

Peter Borek ◽

Laurencia Perea ◽

...

Keyword(s):

Total Pancreatectomy ◽

Graft Function ◽

Β Cell ◽

Term Stability ◽

Long Term Stability ◽

Islet Autotransplantation

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Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis: Do Patients with Prior Pancreatic Surgery Have Different Outcomes?

The American Surgeon ◽

10.1177/000313481207800826 ◽

2012 ◽

Vol 78 (8) ◽

pp. 893-896 ◽

Cited By ~ 13

Author(s):

Katherine A. Morgan ◽

Tom Theruvath ◽

Stefanie Owczarski ◽

David B. Adams

Keyword(s):

Quality Of Life ◽

Chronic Pancreatitis ◽

Pancreatic Surgery ◽

Total Pancreatectomy ◽

Prior History ◽

Insulin Requirements ◽

Surgery Group ◽

History Of ◽

Islet Autotransplantation

Total pancreatectomy with immediate islet autotransplantation (IAT) can be an effective therapy in patients with chronic pancreatitis. Patient selection criteria for radical resection are not well defined. The impact of prior pancreatic surgery on quality of life outcomes in patients undergoing IAT is evaluated. A retrospective review of a prospectively collected database of patients undergoing pancreatectomy with islet autotransplantation was undertaken. Patients having undergone prior pancreatic resection and/or drainage procedures were compared with those without prior pancreatic operative history. Sixty-one patients underwent pancreatectomy with IAT for pancreatitis. Twenty-three patients had a prior history of pancreatic surgery (Group S); 38 had no prior history of pancreatic surgery (Group NS). Demographics between the groups were similar. Patients in Group S took more daily oral morphine equivalents and had a lower psychological quality of life preoperatively. Operative times and blood loss were similar between the patient groups. Islet yields were lower for patients in Group S. Postoperatively, daily insulin requirements at 6 months and 1 year trended higher in Group S. Postoperative quality of life scores at 6 months were improved and similar between the groups. Quality of life metrics continued to improve beyond 1 year of follow-up, with a trend toward greater improvement in the NS Group. Total pancreatectomy for chronic pancreatitis improves quality of life in patients with and without a prior history of pancreatic surgery. This study demonstrates that IAT without preceding pancreatic surgery may enhance outcomes measured by long term insulin requirements and quality of life.

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P.107: Safety of Islet Transplantation in the Preperitoneal Space in Addition to Intraportal Infusion in Clinical Total Pancreatectomy With Islet Autotransplantation

Transplantation Journal ◽

10.1097/01.tp.0000804516.65092.91 ◽

2021 ◽

Vol 105 (12S1) ◽

pp. S39-S39

Author(s):

Nicholas Onaca ◽

Kenjiro Kumano ◽

Jordan Mattke ◽

Carly Darden ◽

Srividya Vasu ◽

...

Keyword(s):

Islet Transplantation ◽

Total Pancreatectomy ◽

Preperitoneal Space ◽

Islet Autotransplantation ◽

Intraportal Infusion

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Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation

Journal of Diabetes Research ◽

10.1155/2020/9282310 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Neha Verma ◽

Amer Rajab ◽

Jill Buss ◽

Luis Lara ◽

Kyle Porter ◽

...

Keyword(s):

Basal Insulin ◽

Cell Function ◽

Total Pancreatectomy ◽

Inverse Correlation ◽

Insulin Requirement ◽

Exocrine Function ◽

Long Term Outcome ◽

Insulin Requirements ◽

Islet Autotransplantation

Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield, and post-TPIAT glucose management data to further understand their relationship. Islet yield, glucose level, and insulin requirement for 72 hours postoperatively were collected for a total of 13 TPIAT recipients between 9-2013 and 9-2018. In addition, their glucose control and basal insulin requirements at 3, 6, and 12 months post-TPIAT were analyzed. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median postoperative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin, or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour postoperatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6, and 12 months showed a positive correlation. Despite the finding of inverse correlation of islet yield with long-term basal insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies. The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long-term insulin management following TPIAT. This observation may identify a high-risk group of patients in need of more intensive diabetes education and insulin treatment prior to hospital discharge.

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Deficient Glucagon Response to Hypoglycemia During a Mixed Meal in Total Pancreatectomy/Islet Autotransplantation Recipients

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2017-02182 ◽

2018 ◽

Vol 103 (4) ◽

pp. 1522-1529 ◽

Cited By ~ 6

Author(s):

Lindsey D Bogachus ◽

Melena D Bellin ◽

Adrian Vella ◽

R Paul Robertson

Keyword(s):

Total Pancreatectomy ◽

Mixed Meal ◽

Islet Autotransplantation

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119-OR: Total Pancreatectomy with Islet Autotransplantation in Diabetic and Prediabetic Patients with Intractable Chronic Pancreatitis

Diabetes ◽

10.2337/db20-119-or ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 119-OR

Author(s):

PIOTR J. BACHUL ◽

PETER BOREK ◽

ROI ANTEBY ◽

LINDSAY BASTO ◽

LAURENCIA PEREA ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Total Pancreatectomy ◽

Islet Autotransplantation

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Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection

Viruses ◽

10.3390/v13050904 ◽

2021 ◽

Vol 13 (5) ◽

pp. 904

Author(s):

Ramin Raul Ossami Saidy ◽

Irina Sud ◽

Franziska Eurich ◽

Mustafa Aydin ◽

Maximilian Paul Postel ◽

...

Keyword(s):

Liver Transplantation ◽

Overall Survival ◽

Hepatitis B ◽

Graft Function ◽

Passive Immunization ◽

Standard Regimen ◽

Long Term Follow Up ◽

Hdv Infection ◽

End Stage

Patients after LT due to combined HBV/HDV infection are considered to be high-risk patients for recurrence of hepatitis B and D. To date, life-long prophylaxis with hepatitis B immunoglobulin (HBIG) and replication control with nucleos(t)ide analogs (NA) remains standard. We examined the course of 36 patients that underwent liver transplantation from 1989 to 2020 for combined HBV/HDV-associated end-stage liver disease in this retrospective study. Seventeen patients eventually discontinued HBIG therapy for various reasons. Their graft function, histopathological findings from routine liver biopsies and overall survival were compared with those that received an unaltered NA-based standard regimen combined with HBIG. The median follow-up was 204 and 227 months, respectively. The recurrence of HBV was 25% and did not differ between the groups of standard reinfection prophylaxis NA/HBIG (21.1%) and HBIG discontinuation (29.4%); (p = 0.56). No significant differences were found regarding the clinical course or histopathological aspects of liver tissue damage (inflammation, fibrosis, steatosis) between these two groups. Overall, and adjusted survival did not differ between the groups. Discontinuation of HBIG in stable patients after LT for combined HBV/HDV did not lead to impaired overall survival or higher recurrence rate of HBV/HDV infection in this long-term follow-up. Therefore, the recommendation of the duration of HBG administration must be questioned. The earliest time of discontinuation remains unclear.

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