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Salvage Islet Auto Transplantation After Relaparatomy
Gianpaolo Balzano1, Rita Nano, Paola Maffi
11 Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy. 2 Diabetes Research Institute; IRCCS San Raffaele Scientific Institute, Milan, Italy. 3 Clinical Transplant Unit, Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute, Milan, Italy. 4 Humanitas Clinical and Research Center, Pancreatic Surgery, Rozzano, Italy. 5 Humanitas Clinical and Research Center, Diabetology, Rozzano, Italy. 6 Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 7 Vita-Salute San Raffaele University, Milan, Italy. 8 Humanitas University, Department of Biomedical Sciences, Rozzano, Italy.
Background:
To assess feasibility, safety, and metabolic outcome of islet auto transplantation (IAT) in patients undergoing completion pancreatectomy because of sepsis or bleeding after pancreatic surgery.
Methods:
From November 2008 to October 2016, approximately 22 patients were candidates to salvage IAT during emergency relaparotomy because of postpancreatectomy sepsis (n = 11) or bleeding (n = 11). Feasibility, efficacy, and safety of salvage IAT were compared with those documented in a cohort of 36 patients who were candidate to simultaneous IAT during nonemergency preemptive completion pancreatectomy through the pancreaticoduodenectomy.
Results:
The percentage of candidates that received the infusion of islets was significantly lower in salvage IAT than simultaneous IAT (59.1% vs 88.9%, P = 0.008), mainly because of a higher rate of inadequate islet preparations. Even if microbial contamination of islet preparation was significantly higher in candidates to salvage IAT than in those to simultaneous IAT (78.9% vs 20%, P < 0.001), there was no evidence of a higher rate of complications related to the procedure. Median follow-up was 5.45 ± 0.52 years. Four (36%) of 11 patients reached insulin independence, 6 patients (56%) had partial graft function, and 1 patient (9%) had primary graft nonfunction. At the last follow-up visit, median fasting C-peptide was 0.43 (0.19-0.93) ng/mL; median insulin requirement was 0.38 (0.04-0.5) U/kg per day, and median HbA1c was 6.6% (5.9%-8.1%). Overall mortality, in-hospital mortality, metabolic outcome, graft survival, and insulin-free survival after salvage IAT were not different from those documented after simultaneous IAT.
Conclusions:
Our data demonstrate the feasibility, efficacy, and safety of salvage IAT after relaparotomy.