Total Pancreatectomy With Percutaneous Islet Autotransplant After Remote Islet Processing: A Viable Paradigm?

IF 1.7 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Pancreas Pub Date : 2024-11-01 Epub Date: 2024-06-03 DOI:10.1097/MPA.0000000000002376

Kyle A Lewellen, Thomas K Maatman, Michael G House, Kathleen McGreevy, Melissa K Cavaghan, Michael R Dorwart, Evan L Fogel, Paul M Haste, Anne Mary Montero, Alexandra M Roch, Nicholas J Zyromski

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引用次数: 0

Abstract

Objectives: Total pancreatectomy with islet autotransplant (TPIAT) is important therapy for select chronic pancreatitis (CP) patients. The specialized technique of islet isolation limits widespread TPIAT use. We hypothesized that remote islet isolation provides satisfactory islet yield and perioperative outcomes.

Methods: A retrospective review of TPIAT patients between 2020 and 2022 was conducted. Islet isolation was performed off-site, with percutaneous intraportal islet autotransplant (IAT) completed the morning following pancreatectomy. Demographics and perioperative outcomes were analyzed.

Results: Fourteen patients underwent TPIAT; median age was 43 (interquartile range, 12.5) years. Operation occurred 7.5 (14.8) years after pancreatitis diagnosis. The most common pancreatitis etiology was genetic (50%). All patients underwent preoperative endoscopic therapy; three underwent prior pancreatectomy. Operative time was 236 (51) minutes; subsequent percutaneous IAT time was 87 (35) minutes. The islet equivalent (IEQ)/kilogram (kg) yield was 3456 (3815) IEQ/kg. Nine patients had positive islet cultures. Two thromboembolic events and one bacteremia occurred. One perihepatic hematoma occurred after percutaneous portal venous access. The median postoperative length of stay was 14.5 days, and five patients (36%) were readmitted within 90 days. All patients were discharged home on insulin. No mortality occurred.

Conclusions: Total pancreatectomy with remote islet isolation provides excellent islet yield for autotransplant and satisfactory perioperative outcomes.

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全胰腺切除术与远程胰岛处理后的经皮胰岛自体移植：可行的范例？

目的：带胰岛自体移植的全胰腺切除术（TPIAT）是治疗部分慢性胰腺炎（CP）患者的重要方法。胰岛分离的专业技术限制了 TPIAT 的广泛应用。我们假设远程胰岛分离可提供令人满意的胰岛产量和围手术期结果：方法：回顾性分析 2020 年至 2022 年间的 TPIAT 患者。胰岛分离在异地进行，经皮门静脉内胰岛自体移植（IAT）在胰腺切除术后第二天早上完成。对人口统计学和围手术期结果进行了分析：14名患者接受了TPIAT；中位年龄为43岁[四分位距为12.5岁]。手术发生在胰腺炎确诊后 7.5 [14.8] 年。最常见的胰腺炎病因是遗传（50%）。所有患者均接受了术前内镜治疗，其中三人接受了胰腺切除术。手术时间为 236 [51] 分钟；随后的经皮 IAT 时间为 87 [35] 分钟。胰岛当量（IEQ）/公斤（kg）产量为3,456 [3,815] IEQ/公斤。九名患者的胰岛培养呈阳性。发生了两次血栓栓塞事件和一次菌血症。经皮门静脉入路后出现了一个肝周血肿。术后住院时间中位数为 14.5 天，5 名患者（36%）在 90 天内再次入院。所有患者均使用胰岛素出院回家。无死亡病例发生：结论：全胰腺切除术与远端胰岛分离为自体移植提供了极佳的胰岛产量，围手术期效果令人满意。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreas 医学-胃肠肝病学

CiteScore

4.70

自引率

3.40%

发文量

289

审稿时长

1 months

期刊介绍： Pancreas provides a central forum for communication of original works involving both basic and clinical research on the exocrine and endocrine pancreas and their interrelationships and consequences in disease states. This multidisciplinary, international journal covers the whole spectrum of basic sciences, etiology, prevention, pathophysiology, diagnosis, and surgical and medical management of pancreatic diseases, including cancer.