Patient and Procedural Factors Associated With Increased Islet Cell Yield in Total Pancreatectomy With Islet Autotransplantation

Abstract

Introduction: Total pancreatectomy with islet autotransplantation (TP-IAT) provides pain relief to highly select patients with recurrent acute and/or chronic pancreatitis. However with variable outcomes and no standardized guideline for patient selection, it is important to refine islet manipulation procedures and patient selection characteristics to optimize outcomes. Success of the procedure depends on a high number of isolated islet equivalents. This study explores the patient and procedural characteristics associated with high islet cell yield. Methods: This study evaluated patients who underwent TP-IAT at Dartmouth Hitchcock Medical Center from 2012 to 2016. 38 patients met inclusion criteria. Odds ratios with 95% confidence intervals were found for various patient and procedural characteristics listed in Table 1. The primary clinical outcome was the number of isolated islet equivalents per kilogram body weight (IEQ/Kg), defined as IEQ/Kg >2,500.Table: Table. Factors Associated with Successful Islet Cell Yield During TPIATResults: All patient factors and procedural fields evaluated are listed in Table 1. Patients with no CT/MRI evidence of chronic pancreatitis showed statistically significant higher odds of success (OR=29, P=0.02). Patients without pancreatic duct stones or parenchymal stones were associated with higher odds of success (OR=23, P=0.02 and OR=55, P=0.002, respectively). Islet cell suspensions positive for cultures or positive gram stains were associated with lower chances of success (OR=0.06, P=0.02, and OR=0.48, P=0.01, respectively). Patients with preoperative HgbA1c greater than 5.6 were associated with lower odds of success (OR=0.13, P=0.02). Conclusion: This investigation found that patients without CT/MRI evidence of chronic pancreatitis, without bacterial infections, and without pancreatic duct or parenchymal stones are more likely to attain successful islet cell yields. Additionally, patients with preoperative HgbA1c less than 5.6 were associated with higher outcomes of success. These factors should be considered when selecting patients for TP-IAT.