Article
Indications for islet autotransplantation – experience of the centre in Dresden
Indikationen zur Inselautotransplantation – Erfahrungen des Dresdner Zentrums
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Authors
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Stefan Ludwig
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Dresden, Deutschland
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Barbara Ludwig
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Medizinische Klinik und Poliklinik III, Dresden, Deutschland
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Stefan Bornstein
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Medizinische Klinik und Poliklinik III, Dresden, Deutschland
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Jürgen Weitz
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Dresden, Deutschland
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Robert Grützmann
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Dresden, Deutschland
| Published: | April 24, 2015 |
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Outline
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Introduction: Traditionally islet autotransplantation (IAT) is performed to improve glycemic control after extended pancreatectomy mainly in patients with chronic pancreatitis. Extending the indication for islet autotransplantation to patients with major complications following pancreas surgery for various reasons and to patients with pancreatic malignancies or pre-malignancies (i.e. IPMN) has been discussed controversially. The aim of this study was to assess metabolic outcomes of IAT in 12 patients undergoing pancreatic surgery for either benign or malignant disease.
Material and methods: In addition to chronic pancreatitis, indications for islet autotransplantation were pancreatic anastomosis insufficiencies requiring completion pancreatectomy and distal/complete pancreatectomy for benign/borderline neoplasm of pancreatic body-neck including IPMN. 12 patients were followed metabolically by SMBG, glucose tolerance test and mixed meal test.
Results: 12 patients were autotransplanted with 150.000+/-50.000 islet equivalents. The autotransplantation procedure was performed without complications. 2/12 patients died during hospital stay due to septic complications with functioning autografts. The remaining 10 patients showed good primary, 6 month and 1 year graft function with 50% of the patients off insulin. No graft failure was observed. HbA1c levels in all patients were normal after IAT. The mixed meal tolerance test showed similar results as the ivgt test with delayed c-peptide peak and slower return to baseline levels. No adverse events according to transfer of premalignant cells in to the liver was observed.
Conclusion: IAT results in a good glycemic control in all patients preventing overt pancreoprive diabetes with its complications. Although larger data and controlled clinical trials are needed, our limited experience suggests that IAT indications can be possibly extended to selected patients with neoplasm.
