Chronic pancreatitis (CP) represents a highly significant healthcare challenge in Kentucky. To address this need, we created a TP-IAT program to cure patients of this disease. Patients were evaluated by a multi-disciplinary team (transplant surgery, gastroenterology, endocrinology, palliative care, psychology and social work). All KY Medicaid (n=3) and commercial insurance (n=9) payers covered islet processing whereas Medicare (n=2) and out-of-state Medicaid (n=1) did not. From Jan 2015 to Nov 2016, these 15 patients underwent TP-IAT. Median patient age was 50 (range 33-66), 47% were female, 53% were current smokers and etiology for 60% was alcoholic pancreatitis. Median duration of disease was 7 years (range 2-20 years), 20% were diabetic but produced insulin, 80% required pancreatic enzyme replacement, and 100% were taking daily narcotics. All patients failed maximal medical therapy. TP-IAT was performed during the same operation. Patients with more than 15cm water increase in portal pressures were heparinized post operatively. All patients were managed on continuous insulin infusion to maintain blood glucose 80-120 until goal tube feed rates were achieved. Median length of stay (LOS) was 8 days (range 6-55 days). The one prolonged LOS was due to a patient (subsequently found to have Factor V Leiden mutation) that developed portal vein thrombosis managed non-operatively. Only one patient (7%) was readmitted/re-operated on within first 30-days (transverse colon necrosis necessitating resection). For the first 10 patients, marginal ulceration or alkaline reflux gastritis developed in 50% and 40%, respectively. After modifying the pylorus-sparing loop end-to-side duodenojejunostomy to include a Braun enteroenterostomy and afferent limb occlusion with non-cutting stapler, no further marginal ulceration or alkaline reflux gastritis was encountered. We achieved 100% islet function by 3-months, 50% insulin independence by 6-months (excluding pre-operative diabetics), and 86% narcotic independence by 1-year. In conclusion, TP-IAT is a safe and effective therapy for patients even in the early stages of program development. Medicare non-coverage remains a significant barrier for patients.

CITATION INFORMATION: Hughes M, Davis E, Mokshagundam S, Tucker W, Logananthan G, Williams S, Appakalai B. Initial Experince with Total Pancreatectomy-Islet Auto-Transplantation (TP-IAT) for Chronic Pancreatitis at the University of Louisville. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress