Outcomes of Total Pancreatectomyand Islet Autotransplantation, a Single Center Experience
1Transplant Surgery, The Ohio State University, Columbus, OH, 2Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH, 3Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, OH, 4Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH
Meeting: 2019 American Transplant Congress
Abstract number: D287
Keywords: Insulin, Islets, Outcome, Pancreatitis
Session Name: Poster Session D: Pancreas and Islet: All Topics
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Patients with chronic pancreatitis (CP) suffer from severe pain that greatly reduces their quality of life and often leads to long-term narcotic therapy to manage the pain. When other endoscopic or surgical treatment options have failed, patients may be referred for a total pancreatectomy and islet autotransplantation (TPIAT). In TPIAT, the diseased pancreas is removed to alleviate the pain associated with CP, and the insulin-producing islets are isolated and transplanted into the patient’s liver in an attempt to curb the development of surgical diabetes.
*Methods: We describe here the outcomes for patients undergoing TPIAT in the treatment of CP at our institution. To date, we have performed n=15 TPIAT procedures. The average age of patients undergoing TPIAT was 42 years ± 14. The most common diagnosis was idiopathic CP (66%), followed by hereditary CP (33%) and alcohol-induced CP (1%). Patients received an average islet dose of 6879.6 IEq/kg ± 5375.8 (range 957-21865 IEq/kg). The average packed cell volume was 12.2 mL ± 6.5. Portal vein pressure was monitored during infusion, with the average peak portal pressure being 19.0 cmH2O ± 6.3, and the average increase from baseline to peak pressure being 6.6 cmH2O ± 4.8.
*Results: At 1 year post-TPIAT, patients were taking an average of 10.8 units of insulin/day with n=6 patients remaining insulin independent. The average c-peptide level at 1 year post-TPIAT was 1.78 ng/mL ± 1.47, and the average 1 year hemoglobin A1c level was 6.5% ± 1.1. A high correlation was also noted between islet dose (IEq/kg) and c-peptide levels at 1 year post-TPIAT (R = 0.88). Of the n=15 patients undergoing TPIAT at our institution, n=2 patients had previously undergone a Whipple procedure as treatment for CP. Despite having already had the head of the pancreas removed, these patients had an average islet dose of 7238.5 IEq/kg, slightly higher than our patient average. The average insulin requirement for these patients at 1 year post-TPIAT was 14.5 units/day, the average c-peptide levels at 1 year were 0.45 ng/mL, and the average hemoglobin A1c levels were 6.8%.
*Conclusions: These data suggest that TPIAT is a viable treatment for patients with CP, even in patients who have already undergone a Whipple procedure.
To cite this abstract in AMA style:Rajab A, Buss J, Lara LF, Meng S, Kuntz K, Conwell D, Hart PA, Washburn K. Outcomes of Total Pancreatectomyand Islet Autotransplantation, a Single Center Experience [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-total-pancreatectomyand-islet-autotransplantation-a-single-center-experience/. Accessed June 3, 2023.
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