Autologous Islet Research Articles

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

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.

Long-term Tolerance to Islet Transplantation via Targeted Reduction of beta cell-specific T cells.

Activated beta-cell reactive CD4 + and CD8 + T effector cells undergo a profound DNA-damage response which is targetable by small molecule inhibitors of the p53 and cell cycle pathways that lead to apoptosis. The use of a combination of MDM2 and WEE1 inhibitors, which termed "p53 potentiation with checkpoint abrogation" (PPCA), conferred significant therapeutic efficacy in treating mouse models of new onset T1D. Specific targeting of these T effector cells by PPCA results in a loss of inflammatory T cell subsets, notably proliferation CD4 + Th0 and Th1 subsets and CD8 + T effector memory cells, as determined by single cell RNA-seq studies with the preservation of T regulatory cells. When autologous islet grafts are given to established diabetic NOD mice, a single course of PPCA results in long-term islet graft acceptance, restoration of normoglycemia and loss of beta cell specific CD4 + and CD8 + T cells. PPCA shows promise as a potential means of estimating islet graft tolerance in T1D recipients of islet graft transplantation.

Robotic total pancreatectomy with autologous islet cell transplant: safety evaluation and outcomes

Robotic total pancreatectomy with autologous islet cell transplant: safety evaluation and outcomes

Robotic total pancreatectomy with autologous islet cell transplant: safety evaluation and outcomes

Robotic total pancreatectomy with autologous islet cell transplant: safety evaluation and outcomes

Current status of total pancreatectomy with islet autotransplantation for chronic and recurrent acute pancreatitis.

Total pancreatectomy with islet autotransplantation (TPIAT) is an established and effective treatment modality for patients diagnosed with intractable chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). TPIAT primarily aims to manage debilitating pain leading to impaired quality of life among patients with CP or RAP, which can be successfully managed with medical, endoscopic, or surgical interventions. TPIAT is significantly successful in relieving pain associated with CP and improving health-related quality of life outcomes. Furthermore, the complete loss of pancreatic endocrine function attributed to total pancreatectomy (TP) can be compensated by autologous islet transplantation (IAT). Patients receiving IAT can achieve insulin independence or can be less dependent on exogenous insulin compared with those receiving TP alone. Historically, TPIAT has been mainly used in the United States, and its outcomes have been improving due to technological advancements. Despite some challenges, TPIAT can be a promising treatment for patients with CP-related intractable pain. Thus far, TPIAT is not commonly performed in Japan. Nevertheless, it may improve health-related quality of life in Japanese patients with CP, similar to Western patients. This review article aimed to provide an overview of the indications, related procedures, and outcomes of TPIAT and to discuss future prospects in Japan.

Assessment of long-term graft function following total pancreatectomy and autologous islet transplantation: the Leicester experience.

Total pancreatectomy and islet autotransplantation (TPIAT) is a recognised treatment for chronic pancreatitis (CP) with the potential to mitigate or prevent pancreatogenic diabetes. We present our 10-year follow-up of TPIAT patients. The University Hospitals of Leicester performed 60 TPIAT procedures from September 1994 to May 2011. Seventeen patients completed their 10-year assessment and were grouped using the modified Auto-Igls criteria; good response, n=5 (insulin-independent for first 5 years post-TPIAT); partial response, n=6 (insulin requirements <20 iU/day post-TPIAT) and poor response, n=6 (insulin requirements ≥20 iU/day post-TPIAT). C-peptide, haemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were undertaken preoperatively (baseline), then at 3, 6 months and then yearly for 10 years. Data was analysed using analysis of variance (ANOVA). Median C-peptide levels were significantly higher, 120 minutes following OGTT, in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0001). All groups demonstrated preservation of C-peptide release. HbA1c levels were significantly lower in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0003 and P<0.0001). Median fasting glucose levels at 30 and 120 min following OGTT, were significantly lower in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0001 and P<0.0001). TPIAT preserves long-term islet graft functions in 10-year follow up. Even in patients in the poor response group, there is evidence of C-peptide release (>0.5 ng/mL) after OGTT stimulation potentially preventing long-term diabetes-related complications.

Short-term function and immune-protection of microencapsulated adult porcine islets with alginate incorporating CXCL12 in healthy and diabetic non-human primates without systemic immune suppression: A pilot study.

Replacement of insulin-producing pancreatic beta-cells by islet transplantation offers a functional cure for type-1 diabetes (T1D). We recently demonstrated that a clinical grade alginate micro-encapsulant incorporating the immune-repellent chemokine and pro-survival factor CXCL12 could protect and sustain the integrity and function of autologous islets in healthy non-human primates (NHPs) without systemic immune suppression. In this pilot study, we examined the impact of the CXCL12 micro encapsulant on the function and inflammatory and immune responses of xenogeneic islets transplanted into the omental tissue bilayer sac (OB; n = 4) and diabetic (n = 1) NHPs. Changes in the expression of cytokines after implantation were limited to 2-6-fold changes in blood, most of which did not persist over the first 4 weeks after implantation. Flow cytometry of PBMCs following transplantation showed minimal changes in IFNγ or TNFα expression on xenoantigen-specific CD4+ or CD8+ T cells compared to unstimulated cells, and these occurred mainly in the first 4 weeks. Microbeads were readily retrievable for assessment at day 90 and day 180 and at retrieval were without microscopic signs of degradation or foreign body responses (FBR). In vitro and immunohistochemistry studies of explanted microbeads indicated the presence of functional xenogeneic islets at day 30 post transplantation in all biopsied NHPs. These results from a small pilot study revealed that CXCL12-microencapsulated xenogeneic islets abrogate inflammatory and adaptive immune responses to the xenograft. This work paves the way toward future larger scale studies of the transplantation of alginate microbeads with CXCL12 and porcine or human stem cell-derived beta cells or allogeneic islets into diabetic NHPs without systemic immunosuppression.

Medzinárodná autotransplantácia Langerhansových ostrovčekov do portálneho riečiska po totálnej pankreatektómii u pacienta s chronickou hereditárnou pankreatitídou – kazuistika a prehľad súčasnej literatúry

Summary: Chronic pancreatitis with repeated painful relapses is a severe multifactorial, fibroinflammatory syndrome that significantly affects the quality of life of patients, mainly in terms of pain, development of diabetes mellitus, and repeated attacks of acute pancreatitis. Autologous islet transplantation after total pancreatectomy is a potential option in selected patients with severe, recurrent painful episodes of chronic pancreatitis. In our case, we present a patient with severe recurrent chronic pancreatitis. The patient required frequent hospitalizations with repeated stenting of the pancreatic duct. After the confirmation of a genetic mutation, the members of the multidisciplinary session decided to perform a total pancreatectomy with islet autotransplantation. In this case, we present the first international islet cell autotransplantation of Langerhans islets in Slovakia after total pancreatectomy in a patient with chronic hereditary pancreatitis. Key words: hereditary pancreatitis – total pancreatectomy – autotransplantation of Langerhans islets

Response to: Comment on: Pancreatectomy With Islet-Autotransplantation as Alternative for Pancreato-Duodenectomy in Patients With a High-Risk for Postoperative Pancreatic Fistula: The Jury Is Still Out.

We thank Dr Thomas Frederik Stoop and colleagues for their keen interest in our study1 and their words of appreciation for our work. The first issue raised by the authors relates to the risk–benefit balance of total pancreatectomy associated with islet-autotransplantation (TP-IAT) versus pancreatoduodenectomy (PD). As for whether postoperative morbidity is the ideal endpoint for our trial, we point out that the 90-day overall complication rate is the standard primary endpoint of many studies on this topic. Furthermore, as for our trial is concerned, it was an unavoidable choice to ensure study feasibility. In facts, considering the 90-day mortality rate as primary outcome, 464 patients would be needed to detect a statistical difference with adequate power, an unrealistic sample size for a prospective randomized trial on autologous islet transplantation in candidates for pancreatic surgery and at high risk for POPF. Consequently, overall, disease-specific and disease-free survival were included as secondary endpoints. However, the point raised by Stoop and colleagues actually implies a question that goes beyond the results of our trial, namely whether primary total pancreatectomy (TP) in patients at high risk of POPF is justified and preferable to pancreaticoduodenectomy. This question is still very open, and our results suggest that there may be room for an approach based on TP. In our study, as in other recent retrospective single-center series,2-3 a 2%–4% mortality rate after TP is reported and, even in daily clinical practice, the 90-day mortality rate was 4% in centers performing more than 60 PDs per year.4 We are aware of and appreciate the results of the Dutch PORSCH trial, but that study population was not selected for being at high risk of POPF, and therefore, the results of PORSCH cannot be extrapolated to the patients enrolled in our study. A major contribution to the discussion on this topic will be hopefully provided by the recently initiated TETRIS study (NCT05212350), a multicenter RCT in a cohort of patients with a very high risk of POPF, comparing TP and primary pancreatic anastomosis for postoperative outcomes and quality of life. The second issue raised is related to the patient-reported outcomes. We fully agree that quality of life overtime is a highly relevant endpoint when determining the impact of TP on the life of our patients and their families. However, our study was not an appropriate setting to provide meaningful data on this issue. In fact, the heterogeneity of the underlying pancreatic diseases in terms of disease severity and the various adjuvant treatments patients had faced for extended periods of time after surgery were likely to have had a significant impact on patients’ relevant outcomes. The third issue relates to the relevance of glucose control. Islet-autotransplantation resulted in at least partial endogenous insulin secretion in around 90% of patients undergoing TP and good metabolic control at the last follow-up [day 388 (235–1307)] in 62% of the patients without severe hypoglycemic episodes or diabetes-related mortality. We were impressed by the recent results of the Dutch Pancreatic Cancer Group using a bihormonal artificial pancreas in 12 patients after TP. The 7-day follow-up in 9 of the 12 patients who completed the study showed an increased time spent between 70 and 180 mg/dL (time in range) of glucose levels. We hope these data will be confirmed through larger and longer RCTs involving unselected patients who underwent TP. We envision islet transplantation not as an alternative to the use of exogenous insulin and glucose sensor or delivery technology in patients with TP, but as a complementary and synergistic treatment for diabetes following TP since the bihormonal artificial pancreas hopefully wish to perform even better in patients with autologous islet transplantation after TP. We completely agree with Stoop and colleagues that the jury is still out. However, our study confirmed that IAT is a feasible choice in patients with pancreas diseases other than chronic pancreatitis, and this should be viewed as an important advance in the field. The decision to perform TP-IAT requires assessing the risk–benefit ratio of this procedure in each individual case and should be discussed with the candidate patient in the context of multidisciplinary teams. High-volume referral centers for pancreatic surgery should be encouraged to collaborate with an islet isolation facility to provide access to IAT when appropriate. At last, in our conclusion, we used “may” to convey a degree of uncertainty. The results of our study are not a final ruling and we hope the jury is still out also for Stoop and colleagues in their appreciation for the potentials of TP-IAT.

Endocrine Outcome after Total Pancreatectomy with Autologous Islet Transplantation

Endocrine Outcome after Total Pancreatectomy with Autologous Islet Transplantation

A randomized controlled pilot trial of etanercept and alpha-1 antitrypsin to improve autologous islet engraftment

BackgroundIn total pancreatectomy with islet auto-transplantation, successful diabetes outcomes are limited by islet loss from the instant blood mediated inflammatory response. We hypothesized that blockade of the inflammatory response with either etanercept or alpha-1-antitrypsin would improve islet function and insulin independence. MethodsWe randomized 43 participants to receive A1AT (90 mg/kg x 6 doses, n = 13), or etanercept (50 mg then 25 mg x 5 doses, n = 14), or standard care (n = 16), aiming to reduce detrimental effects of innate inflammation on early islet survival. Islet graft function was assessed using mixed meal tolerance testing, intravenous glucose tolerance testing, glucose-potentiated arginine-induced insulin secretion studies, HbA1c, and insulin dose 3 months and 1 year post-TPIAT. ResultsWe observed the most robust acute insulin response (AIRglu) and acute C-peptide response to glucose (ACRglu) at 3 months after TPIAT in the etanercept-treated group (p ≤ 0.02), but no differences in other efficacy measures. The groups did not differ overall at 1 year but when adjusted by sex, there was a trend towards a sex-specific treatment effect in females (AIRglu p = 0.05, ACRglu p = 0.06), with insulin secretion measures highest in A1AT-treated females. ConclusionOur randomized trial supports a potential role for etanercept in optimizing early islet engraftment but it is unclear whether this benefit is sustained. Further studies are needed to evaluate possible sex-specific responses to either treatment. Clinical trial notationThis study was performed under an Investigational New Drug Application (IND #119828) from the Food and Drug Administration and was registered on clinicaltrials.gov (NCT#02713997).

Pancreatitis-Associated PRSS1-PRSS2 Haplotype Alters T-Cell Receptor Beta (TRB) Repertoire More Strongly Than PRSS1 Expression

Pancreatitis-Associated PRSS1-PRSS2 Haplotype Alters T-Cell Receptor Beta (TRB) Repertoire More Strongly Than PRSS1 Expression

Autologe Inseltransplantation bei Pankreaserkrankungen

Pancreas surgery is complicated and associated with substantial risks and even danger of death. The surgical removal of the whole pancreas can be necessary for some indications but results in a severe and demanding form of diabetes for both the patients and treating physician. The method of islet autotransplantation involves taking the pancreas immediately after removal to a special laboratory for processing. Using enzymatic digestion and subsequent isolation and purification processes, pancreatic islets that contain the insulin-producing cells are isolated and then returned to the patient. Thereby, insulin production can be preserved and diabetes-associated burden prevented or attenuated. This case report aims to demonstrate a potential indication for simultaneous autologous islet transplantation and the positive implications for patients.

Elevated islet prohormone ratios as indicators of insulin dependency in auto-islet transplant recipients

Pancreatic islet transplantation has therapeutic potential in type 1 diabetes and is also an established therapy in chronic pancreatitis. However, the long-term transplant outcomes are modest. Identifying indicators of graft function will aid the preservation of transplanted islets and glycemic control. We analyzed beta cell prohormone peptide levels in a retrospective cohort of total pancreatectomy autologous islet transplant patients (n = 28). Proinsulin-to-C-peptide (PI/C) and proIAPP-to-total IAPP (proIAPP/IAPP) ratios measured at 3 months post-transplant were significantly higher in patients who remained insulin dependent at 1 year follow-up. In an immuno-deficient mouse model of human islet transplantation, recipient mice that later became hyperglycemic displayed significantly higher PI/C ratios than mice that remained normoglycemic. Histological analysis of islet grafts showed reduced proportional insulin- and proinsulin-positive area, but elevated glucagon-positive area in grafts that experienced greater secretory demand. Increased prohormone convertase 1/3 was detected in glucagon-positive cells, and glucagon-like peptide 1 (GLP-1) area was elevated in grafts from mice that displayed hyperglycemia or elevated plasma PI/C ratios, demonstrating intra-islet incretin production in metabolically challenged human islet grafts. These data indicate that in failing grafts, alpha cell prohormone processing is likely altered, and incomplete beta cell prohormone processing may be an early indicator of insulin dependency.

304-OR: Proteomic Profile and Inflammatory Response of Islet Stressomes Released during Isolation

Purpose: Islets undergo enormous stress during isolation and peri-transplant periods which causes a significant release of stressomes (exosomes released during stress) . Uncovering the biological role of such vesicles is vital for long-term graft function and survival. Here, we sought to identify the global protein content and significance of stressomes isolated during isolation in autologous islet transplantation (AIT) . Methods: Post-transplant stress was mimicked in vitro by exposing human islets to hypoxia and cytokines (Cyt+Hyp) . Stressome protein contents were characterized by mass spectrometry and immunoblotting. Similar stressomes were also isolated from the islet infusion bag samples of AIT recipients (N=20) . The stressome protein levels were correlated with 1-year AIT outcomes. Finally, these islet stressomes were treated to another set of purified islets and macrophages to find their uptake and immune response. Results: The mass spectrometry analysis has revealed the islet stressomes contain DAMP proteins like histones (H2B, H3, and H4) . The canonical ER stress signal plays a crucial role in the biogenesis of islet stressomes induced by (Cyt+Hyp) . Exosomes isolated from the infusion bags showed an elevated histone level in the insulin-dependent (ID) group. Moreover, high levels of DAMP proteins were positively correlated with increased post-transplant recipients insulin requirements (p=0.029) . The fluorescent confocal microscopy analysis has revealed these stressomes were easily uptaken by the macrophages and also conferred an inflammatory phenotype. Instead, the stressome treated islets showed elevated expression of innate immune receptors like TLR2 and AGTR1. Conclusion: The study has identified the islet stressome global protein content and briefs its prospective to induce islet inflammation and graft loss in AIT. Disclosure P.Saravanan: None. J.Kalivarathan: None. M.F.Levy: Research Support; Vertex Pharmaceuticals Incorporated, Speaker's Bureau; AbbVie Inc., Sanofi Genzyme. M.A.Kanak: None.

Incidence and Significance of Microbiological Results and Antimicrobial Prophylaxis in Patients Undergoing Total Pancreatectomy with Autologous Islet Cell Transplant

Introduction: The impact of microbiological findings in the preservation, cannulation solutions, and final islet cell product is debatable amongst providers taking care of patient undergoing total pancreatectomy with autologous islet cell-transplantation (TPAIT). It is further challenged by the lack of guidelines on the type and duration of antimicrobial prophylaxis needed. We aimed to correlate post-op infections to theses cultures and the efficacy of antimicrobial prophylaxis. Methods: Twenty-two patient’s (February 1, 2018 to August 31, 2021) microbiological data from the preservation, cannulation, and final islet cell cultures and their 60 days post-transplant infections were retrospectively analyzed. Results: Microbial cultures were positive in 5 (22.7%) patient’s preservation solution, 4 (18.2%) cannulation solution, and 6 (27.3%) final products (Table 1). Most common antimicrobial prophylaxis regimens were piperacillin/tazobactam (pip/tazo), vancomycin, and micafungin (n=9). The average duration was seven days (range: 2-10). Six patients were discharged on amoxicillin/clavulanic acid. Three patients (14%) had infections: 2 (9%) had Clostridium difficile (22 and 37 days after surgery), 1 (5%) had Candida albicans growing from the abdominal collection (59 days) with no growth in any of the isolation cultures, and 1 (5%) had Burkholderia cepacia in urine (44 days). Conclusion: Isolation procedure and final product cultures were not associated with any infections. Broad spectrum antimicrobial use intra- and post-operatively and extended oral antimicrobial therapy may have minimized the number of infectious outcomes. Consideration is warranted regarding the use of antimicrobial prophylaxis and duration as some of these agents pose a risk for C. difficile.Tabled 1EP02F-020Final Islet Cell CulturePreservation SolutionCannulation Solution1Yeast like organisms in anaerobic cultureNegativeYeast like organisms in anaerobic culture2Initially resulted as gram positive cocci with final identification as Granulicatella adiacensNegativeInitially resulted with gram negative rods in both aerobic and anaerobic cultures. Final report of Klebsiella pneumonia in the aerobic culture and Enterobacter species in anaerobic culture.3Streptococcus massiliensis from aerobic cultureNegativeNegative4Yeast like organisms in anaerobic cultureGram negative rods in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic cultures5NegativeGram positive rods in anaerobic cultureNegative6Gram positive cocci in anaerobic cultureGram negative rods in aerobic cultureNegative7Gram positive cocci in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic cultures8NegativeGram positive cocci in anaerobic cultureNegative Open table in a new tab

306.3: Safety and Efficacy of Total Pancreatectomy and Autologous Islet Cell Transplantation Compared to Parenchymal Preserving Pancreatic Surgery for Pancreatitis

306.3: Safety and Efficacy of Total Pancreatectomy and Autologous Islet Cell Transplantation Compared to Parenchymal Preserving Pancreatic Surgery for Pancreatitis

Targeting CXCR1/2 in the first multicenter, double-blinded, randomized trial in autologous islet transplant recipients

Several cytokines and chemokines are elevated after islet infusion in patients undergoing total pancreatectomy with islet autotransplantation (TPIAT), including CXCL8 (also known as interleukin-8), leading to islet loss. We investigated whether use of reparixin for blockade of the CXCL8 pathway would improve islet engraftment and insulin independence after TPIAT. Adults without diabetes scheduled for TPIAT at nine academic centers were randomized to a continuous infusion of reparixin or placebo (double-blinded) for 7days in the peri-transplant period.Efficacy measures included insulin independence (primary), insulin dose, hemoglobin A1c (HbA1c ), and mixed meal tolerance testing. The intent-to-treat population included 102 participants (age 39.5±12.2years, 69% female), n=50 reparixin-treated, n=52 placebo-treated. The proportion insulin-independent at Day 365 was similar in reparixin and placebo: 20% vs. 21% (p=.542). Twenty-seven of 42 (64.3%) in the reparixin group and 28/45 (62.2%) in the placebo group maintained HbA1c ≤6.5% (p=.842, Day 365). Area under the curve C-peptide from mixed meal testing was similar between groups, as were adverse events. In conclusion, reparixin infusion did not improve diabetes outcomes. CXCL8 inhibition alone may be insufficient to prevent islet damage from innate inflammation in islet autotransplantation. This first multicenter clinical trial in TPIAT highlights the potential for future multicenter collaborations.

Use of Continuous Glucose Monitoring (cgm) to Improve Identification of Hypoglycemia Pre- and Postoperatively for Patients Undergoing Total Pancreatectomy with Autologous Islet Transplant (tpait)

Use of Continuous Glucose Monitoring (cgm) to Improve Identification of Hypoglycemia Pre- and Postoperatively for Patients Undergoing Total Pancreatectomy with Autologous Islet Transplant (tpait)

Use of Continuous Glucose Monitoring for evaluation of hypoglycemia pre- and post-operatively for patients undergoing Total Pancreatectomy with Autologous Islet Cell Transplant.

Total pancreatectomy with autologous islet transplant (TPAIT) is indicated for patients with chronic pancreatitis to improve quality of life while reducing complications from hypoglycemia. Continuous glucose monitoring (CGM) was used to assess overall islet function and the incidence of hypoglycemia pre- and post-operatively. Nineteen patients who underwent TPAIT at a single center from 2018 to 2020 were included. Pre-operatively, patients were defined by diabetic status. HbA1c, stimulated C-peptide, and CGM were used to characterize glycemic function. Pre-operatively, three patients had diabetes, and 16 patients did not have diabetes. Eight out of 16 non-diabetic patients were insulin independent (50%). Of six non-diabetic patients with>10% hypoglycemia on pre-operative CGM, 33% were insulin-independent post-operatively (P=.3). Of non-diabetic patients with ≥ 80% time in the euglycemic range, 62% were insulin-independent post-operatively (P=.2). For patients without diabetes, the median percent time in hypoglycemic range was reduced from 8% to 1% (P=.001). Delta C-peptide had a positive correlation with islet yield (P=.03). Conventional evaluation of TPAIT patients assesses primarily beta cell function. As pancreatogenic diabetes is concerning principally for the risk of hypoglycemia, assessment of alpha cell function can improve the quality of care. CGM better captures islet function and increases the identification of hypoglycemia.