Journal of Pancreatology (Jun 2020)

Total pancreatectomy with islet autotransplantation in diabetic and pre-diabetic patients with intractable chronic pancreatitis

  • Piotr J. Bachul, MD,
  • Damian J. Grybowski, MD,
  • Roi Anteby, MD,
  • Lindsay Basto, RN, MSN,
  • Laurencia Perea, RN, BSN,
  • Karolina Golab, PhD,
  • Ling-Jia Wang, MD, PhD,
  • Martin Tibudan, MS,
  • Angelica P. Gutierrez, MD,
  • Michal Komorniczak, MD,
  • Sajan Nagpal, MD,
  • Aaron Lucander, MD,
  • John Fung, MD, PhD,
  • Jeffrey B. Matthews, MD,
  • Piotr Witkowski, MD, PhD

DOI
https://doi.org/10.1097/JP9.0000000000000048
Journal volume & issue
Vol. 3, no. 2
pp. 86 – 92

Abstract

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Abstract. Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment option for non-diabetic patients with intractable chronic pancreatitis. The outcome and potential benefits for pre-diabetic and diabetic patients are less well established. Thirty-four patients underwent TPIAT were retrospectively divided into 3 groups according to pre-operative glycemic control: diabetes mellitus (DM) (n = 5, 15%), pre-DM (n = 11, 32%) and non-DM (n = 18, 54%). Pre-operative fasting c-peptide was detectable and similar in all 3 groups. Islet yield in the DM group was comparable to pre-DM and non-DM groups (median islet equivalents [IEQ] was 191,800, 111,800, and 232,000 IEQ, respectively). Patients received islet mass of over the target level of 2000 IEQ/kg in pre-DM and DM at lower but clinically meaningful rates compared to the non-DM group: 45% (5/11) and 60% (3/5) for a combined 50% (8/16) rate, respectively, compared to 83% (15/18) for the non-DM group. At 1 year, fasting c-peptide and HbA1c did not differ between DM and pre-DM groups but c-peptide was significantly higher in non-DM. Islet transplantation failed (negative c-peptide) only in 1 patient. Pre-operatively, all patients experienced pancreatic pain with daily opioid dependence in 60% to 70%. Pancreatic-type pain gradually subsided completely in all groups with no differences in other painful somatic symptoms. Diabetic patients with measurable pre-operative c-peptide can achieve similar benefit from TPIAT, with comparable outcomes to pre-diabetic and non-diabetic patients including pain relief and the metabolic benefit of transplanted islets. Not surprisingly, endocrine outcomes for diabetic and pre-diabetics patients are substantially worse than in those with normal pre-operative glucose control.