Introduction: Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment for refractory chronic pancreatitis (CP). Chronic inflammation leads to fibrosis formation in pancreas and it makes pancreas texture harder. The degree of fibrosis varies in every pancreas and it affects the delivery of islet isolation enzyme through pancreatic duct. We analyzed correlation of pancreas texture on the outcome of islet isolation and transplantation.

Method: 119 patients who underwent TPIAT from 2006 to 2016 at our center were retrospectively analyzed. Pancreatic conditions were evaluated and classified by trained surgeons as soft pancreas (SP), firm pancreas (FMP) and fibrotic pancreas (FBP) based on texture. Patient characteristics, isolation process, and transplant/metabolic outcomes were assessed against pancreas texture.

Result: The numbers of patients in SP, FMP, FBP groups were 31, 44, and 44 respectively. The mean age in SP, FMP and FBP groups were 36.9, 42.2, and 42.7 years respectively. Body weight and BMI had no significant difference. The mean disease duration of CP was 7.8, 6.6, and 7.3 years in SP, FMP and FBP groups respectively. Glycemic control was significantly better in SP group when compared to FMP and FBP groups ([Delta]C-peptide; p=0.004, HbA1c; p=0.0002). Pancreas weight did not significantly differ among of these groups, however FBP showed significantly higher undigested pancreas weight (p<0.0001) despite of longer digestion time (p=0.045). FBP group had significantly lower islet tissue volume (p=0.02) and lower islet count (p<0.0001). Purification was performed in 80.6%, 50% and 20.4% in SP, FMP and FBP groups respectively. Among metabolic outcomes, FBP group required significantly larger insulin usage at 3 months and 6 months after transplantation (SP vs FMP vs FBP; 12.0±2.5, 12.5±2.6, and 20.2±2.8 units at 3 months p=0.048; 11.7±3.3, 10.6±3.1, and 19.3±3.1 units in 6 months, p=0.002), while HbA1c was 6.3±0.2, 6.4±0.3, and 6.9±0.2 % at 3 months; 6.5±0.2, 6.4±0.2, and 7.5±0.3 % at 6 months.

Conclusion: Assessment of pancreatic texture prior to isolation is a useful tool for predicting islet isolation and metabolic outcomes. Since fibrotic pancreas is a result of long term CP duration, early implementation of TPIAT may result in improved outcomes.

CITATION INFORMATION: Yoshimatsu G, Khadka M, Lawrence M, Appakalai B, Naziruddin B. Impact of Pancreatic Texture Assessment on Islet Isolation and Metabolic Outcome After TPIAT. Am J Transplant. 2017;17 (suppl 3).

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