Can Autologous Islet Cell Transplant Be a Comparable Choice to Parenchymal Preserving Surgery for Patients with Chronic Pancreatitis with Respect to Glycemic Control?
University of North Carolina, Chapel Hill, NC
Meeting: 2020 American Transplant Congress
Abstract number: A-258
Keywords: Islets, Pancreas, Pancreatitis, Post-transplant diabetes
Session Information
Session Name: Poster Session A: Pancreas and Islet: All Topics
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: The aim of this study is to examine the difference in glycemic outcomes between total pancreatectomy and autologous islet cell transplant (TPAIT) and parenchymal preserving surgery (PPS) to evaluate if the odds of post-operative hyper- and hypoglycemic events should influence the type of surgery chosen for chronic pancreatitis(CP).
*Methods: All patients undergoing CP surgery at a single center under a single surgeon from February 2017 to September 2019 were included. The patients were divided into 2 groups: Group 1 – TPAIT and Group 2 – PPS. The groups were further divided between preoperatively diabetic/pre-diabetic (PreDM/DM) and non-diabetic (NDM) patients.
*Results: 32 patients underwent surgery for CP [14 (43.8%) TPAIT and 18 (56.2%) PPS – 6 (18.8%) Whipple procedures, 9 (28.1%) distal pancreatectomies, and 3 (16.7%) duct drainage procedures]. In Group 1, 6 (42.9%) patients were PreDM/DM preoperatively. Following TPAIT, 5 (35.7%) patients were insulin independent at discharge, of which 4 (28.6%) remain off insulin at current follow up. When stratified by preoperative diabetes status, there were no statistically significant differences in insulin requirement until 3 months, at which time all PreDM/DM patients remained on insulin, but NDM patients began weaning off (p=0.046). In Group 2, 12 (66.7%) were PreDM/DM preoperatively but, there was no significant difference in insulin requirement throughout the hospital stay. When comparing TPAIT to PPS, there was a significant difference in number of patients requiring insulin in the immediate post-operative period (64.3% vs. 22.2%, p =0.016). However, even when stratified by pre-operative diabetes status, there was no significant difference in insulin requirement in either group by 3 months (p=0.134). The odds of requiring insulin was significantly higher at discharge for TPAIT patients (OR 38.1, 95% CI 1.1-1369.3); however, these higher odds decreased by 3 months post-operatively (OR 5.4, 95% CI 0.08-366.8). No patient in either group experienced severe hypoglycemic events or hypoglycemic unawareness.
*Conclusions: While there is a higher odds of developing insulin dependence following TPAIT, this decreases over time. TPAIT can help reduce hypoglycemic complications, hence insulin requirement should not cause hesitation in offering TPAIT to those with diffuse pancreatic disease.
To cite this abstract in AMA style:
Williams BM, Baldwin X, Vonderau JS, Hanson M, Desai CS. Can Autologous Islet Cell Transplant Be a Comparable Choice to Parenchymal Preserving Surgery for Patients with Chronic Pancreatitis with Respect to Glycemic Control? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/can-autologous-islet-cell-transplant-be-a-comparable-choice-to-parenchymal-preserving-surgery-for-patients-with-chronic-pancreatitis-with-respect-to-glycemic-control/. Accessed June 15, 2021.« Back to 2020 American Transplant Congress