Islet Autotransplantation in Focal Intraductal Papillary Mucinous Neoplasms: Evaluating Feasibility, Safety, and Metabolic Outcomes in Pancreatic Resection.

Abstract

Islet auto transplantation (IAT) is a potential therapeutic option for patients undergoing pancreatectomy to preserve endocrine function, but its role in patients with intraductal papillary mucinous neoplasms (IPMN) remains controversial due to oncological concerns. This study evaluates the feasibility, safety, and metabolic outcomes of IAT in seven patients with focal IPMN who underwent pancreatectomy between 2008 and 2023, following the Milan protocol. Primary outcomes included the technical success of islet isolation and the absence of tumor dissemination. Secondary outcomes involved insulin independence and metabolic control post-transplantation. Islet isolation success was variable, with four patients meeting the criteria for transplantation. The average islet yield was 1,097 islet equivalents per kilogram of body weight (range: 219-1,833 IEQ/kg). No patients experienced complications related to islet infusion, and there was no evidence of tumor recurrence or metastasis during a mean follow-up of 7.9 years (range: 3.99-11.88 years). IAT recipients demonstrated preserved insulin secretion, while non-transplanted patients developed diabetes. These findings support the feasibility and safety of IAT in carefully selected patients with focal IPMN, providing promising metabolic outcomes. The results open the possibility to initiate larger cohort studies and explore the potential to expand the population of patients who could benefit from this approach.