Total pancreatectomy with islet autotransplantation is a major surgical procedure for which it is desirable to minimize the total transplanted tissue volume (TV) and the turnaround time for returning islets to the patient. Islet isolation process dissociates islets and exocrine cells and the total TV collected varies depending upon donor characteristics, fibrotic nature and pathological status of exocrine cells. Predicting the digest TV and the potential need for tissue purification, shorten the OR wait time. In this study, 286 isolations from CP pancreases intended for IAT was retrospectively analyzed, with the recovered total digest TV and digest TV per gram of pancreas as the outcomes of interest. Factors affecting the TV (age, gender, height, weight, BMI, severity of fibrosis (0-10 scale), pancreas weight, collagenase & neutral protease (NP) dose used and ratio, and % pancreas digested) were screened in multivariate analysis. Similar analysis was done on data from cadaveric donors intended for allo-transplantation (n=39) and compared to the CP cases.
|Cadaveric (n=39)||Mild Fibrosis (n=85)||Moderate (n=118)||Severe (n=83)|
|Pancreas weight (g)||103||80||70||52|
|Digest tissue volume (cc)||40||24||17||6|
|Digest tissue vol/g pancreas||0.39||0.30||0.23||0.11|
|Digest islet count (IEQ)||758092||360117||297348||153343|
|Transplanted IEQ||575130 (n=25)*||309744||263482||152810|
Based on the analysis of the CP cases, an equation was derived for predicting the total digest TV in CP pancreases in the isolation lab. Using multivariate regression analysis, it was concluded that the total TV and TV per gram of pancreas decreases with higher degree of fibrosis (normal (allo), mild, moderate, and severe). Age was negatively correlated with the digest TV, whereas BMI and final pancreas weight were positively correlated. Pancreas weight and severity of fibrosis are the primary predictive factors of TV in the model, with BMI and then age secondary factors. From the model, the following equation was derived: [Digest pellet volume (cc) =7.74-(0.1*Age)+(0.2*BMI)-(2*Severity of fibrosis)+(0.3*Pancreas weight)] Our formula predicts the digest TV with good precision (p<0.0001; R^2 = 0.679) and is a good tool to expedite the islet isolation procedure and minimize patient OR wait time.
To cite this abstract in AMA style:Tiwari M, Wilhelm J, Bellin M, Soltani S, Loganathan G, Dunn T, Chinnakotla S, Vickers S, Pruett T, Beilman G, Sutherland D, Hering B, Balamurugan A. Predicting Digest Tissue Volume of Chronic Pancreatitis Pancreas Intended for Islet Auto-Transplantation (IAT) [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/predicting-digest-tissue-volume-of-chronic-pancreatitis-pancreas-intended-for-islet-auto-transplantation-iat/. Accessed October 27, 2020.
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