Session Name: Pancreas and Islet: All Topics
Session Date & Time: None. Available on demand.
*Purpose: Total pancreatectomy with islet auto-transplant (TPIAT) has become a mainstay treatment for patients who suffer from refractory chronic pancreatitis. It has consistently been shown to reduce narcotic dependence and improve quality of life while simultaneously maintaining partial β cell activity, thus improving glycemic control post-operatively compared to pancreatectomy alone. A subset of patients with chronic pancreatitis already have underlying diabetes prior to surgery. Outcomes for this specific subset of patients has not been independently evaluated. In this study, we performed a comparative analysis of the TPIAT outcomes for diabetic and non-diabetic patient cohorts to determine if it produces the same long-term outcomes in both populations.
*Methods: A total of 77 patients who had undergone TPIAT at Virginia Commonwealth University or Baylor University and were at least 1-year post-op were included in this study. 13 of the 77 patients were diabetic before undergoing TPIAT. Analysis included comparing demographics, pre-op Islet yield, and metabolic and pain outcomes both pre-op and at 1-year post-op. Additionally, the groups were adjusted for only those with islet dose (IE islet cells/kg patient weight) that were within +/- 1 SD of the average for diabetic patients. Once adjusted, metabolic and pain outcomes were again compared at both time points to determine if any of the differences seen were due to dose of islets available for transplant.
*Results: Diabetic patients had higher rates of HTN at the time of transplant (61.5% compared to 25.0% of the non-diabetic group). There were no other differences in demographic variables. There was a significantly higher average islet cell yield in non-diabetic patients. This difference was eliminated when adjusted for islet dose. There was a significantly higher basal glucose and HgBA1c both pre-op and 1-year post-op for the diabetes cohort. These differences did not resolve with adjustment for islet dose. There was no difference in pre-op basal C-peptide, pain score or equivalent narcotic dosage at either the pre-op or 1-year post-op time points. There was no difference between groups in degree of change of basal c-peptide, HgBA1c, basal glucose, or pain score.
*Conclusions: 1 year following TPIAT, both diabetic and non-diabetic patients experienced a worsening of their pre-op glycemic control and improvement in pain score and narcotic dependence. However, neither group experiences a disproportionate degree of those changes. Together, these results suggest that pre-transplant diabetes should not be considered as a contraindication for TPIAT.
To cite this abstract in AMA style:Kanak MA, Spriggs JB, Coughenour P, Kalivarathan J, Saravanan P, Levy M. TPIAT Outcomes in Diabetic and Non-diabetic Patients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/tpiat-outcomes-in-diabetic-and-non-diabetic-patients/. Accessed September 27, 2021.
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