*Purpose: Total pancreatectomy and intraportal islet autotransplantation (TPIAT) is an effective treatment for patients with refractory chronic pancreatitis. Large volume islet preparations cannot always be infused fully intraportally due to rise in portal vein (PV) pressure and risk of PV thrombosis. We previously showed that dissected preperitoneal pouch (preperitoneal space) can serve as an extrahepatic islet transplant site with long-term graft function in syngeneic mouse model. Here, we evaluated the safety of combined sites of intrahepatic and preperitoneal space in clinical TPIAT and analyzed the outcome.

*Methods: Between 2019 and 2020, patients underwent TPIAT using a combined intraportal and preperitoneal pouch technique (IPV+PP) if the infused intraportal islet mass was >4,000 IEQ/kg and PV pressure was > 20mmHg during infusion. Study patients were monitored for complications, and metabolic outcome was assessed and compared with controls who received only intraportally transplanted islets (IPV) or combined intraportal and peritoneal cavity (IPV+PC).

*Results: Ten patients underwent IAT into the PV and preperitoneal pouch. Baseline demographics (age, sex, BMI, pretransplant C-peptide and HbA1c, duration of symptoms) and isolation results (PV pressure, IEQ/kg) of each group are shown in Table 1. There were no serious post-operative complications in IPV+PP group during the first post-transplant admission. At 6 months after IAT, there were no significant differences in glycemic control or graft function among three groups. (Table 1)

*Conclusions: The preperitoneal space is an alternative supplemental IAT site in patients who do not tolerate a full intraportal islet infusion. It is safe, easily accessible and it tolerates large volume islet preparations. Further studies are needed on a larger cohort of patients to validate our results.

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