HPB SO74 - Autologous Islet Transplantation combined with Pancreatic resection in Adults and Children

Abstract

Abstract Background After extended pancreatic resections there is a risk of developing difficult to manage diabetes. The current NHS commissioning criteria only allows autologous islet isolation and transplantation in adult patients having total pancreatectomy for chronic pancreatitis. We present our experience of pancreatic resection combined with autologous islet transplantation (AIT) in both adults and children. Method Patients were assessed for AIT electively or as an emergency if an extended resection was required for trauma. Patients with chronic pancreatitis were assessed for Total Pancreatectomy (TP) by a multi-disciplinary team which included gastroenterologists, diabetes physicians, pain specialists, surgeons and psychiatrists. A similar approach was used in children. Patients were evaluated pre-operatively with a MMT to assess any borderline diabetes. Results 22 (20 adults and 2 children, age range 9-64 yrs) patients underwent pancreas resection with AIT. Two patients had islet isolated remotely (Edinburgh and Kings College). Five received AIT for trauma (one total and four subtotal). Other indications included Chronic Pancreatitis (n=17) one of which had Familial Hyocalciuric Hypercalcaemia. Ten had gene mutations PRSS1 (n=6) or SPINK1 (n=4). Mean number of islets transplanted were 1534 IEQ/kg ranging in total from <5000- 443,000 IEQ. Patients with mutations received lower numbers of islets. Five remained insulin independent, overall 78% had measurable C peptide. 4/17 Chronic pancreatitis still have abdominal pain. Conclusion Pancreas resection combined with AIT is a viable treatment for both adults and children, even in those presenting with severe pancreatic trauma. Achieving good islet yields in patients with gene mutation remains a problem and is related to the extent of disease and duration of symptoms. Timing of TPIAT in these patients is critical if good outcomes are to be achieved.