Introduction: Total pancreatectomy with islet autotransplantation (TPIAT) provides pain relief for patients with chronic pancreatitis (CP) and the potential to ameliorate the resulting endocrine insufficiency. Factors contributing to insulin independence are controversial. The purpose of this study was to analyze the outcomes of patients who underwent TPIAT at a single institution. Methods: From 1/3/07 through 6/12/15, 27 TPIATs were performed. Islets were isolated using the standard Ricordi method and cultures inoculated with both the pancreas transport and the final islet transplant solutions. Outcomes were evaluated utilizing data from the electronic medical record and a telephone-based questionnaire. Results: 9 patients were male (33%), and 18 female (67%). The median duration of CP prior to transplantation was 4.1 years, the mean islet equivalents (IEQ) transplanted was 188,556, and IEQ/kg body weight was 2,693. There was 1 mortality 3-years post-transplant due to unrelated comorbidities. 6 patients (23.1%) developed bacterial growth from the final transplant solution — none of whom became insulin independent. 19 patients were successfully contacted prospectively. 7 patients (25.9% of the cohort and 33.3% of non-colonized pancreata) were insulin independent after a mean follow up time of 42.3 months.

Discussion: Long-term rates of insulin independence were comparable to other institutional studies. Patients who gained insulin independence were predominantly female (5/7) with a shorter duration of CP and higher yield of IEQ and IEQ/kg body weight. This trend was reversed for patients who developed bacterial growth. Although not causative, bacterial growth is likely indicative of multiple pancreatic interventions and a more inflammatory milieu in the context of a longer duration of chronic pancreatitis. This information suggests that patients likely to suffer from unremitting pancreatitis would benefit from earlier intervention with TPIAT. Further research is needed to determine the causative processes behind these trends and how to identify patients for early intervention.

CITATION INFORMATION: Jolissaint J, Langman L, DeBolt C, Wang A, Strand D, Zaydfudim V, Adams R, Brayman K. Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis: Considerations for Early Intervention. Am J Transplant. 2016;16 (suppl 3).

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