Resident Physician Dartmouth-Hitchcock Medical Center Lebanon, NH
Christopher M. Navas, MD, Kerrington D. Smith, MD, Sushela S. Chaidarum, MD, PhD, Timothy B. Gardner, MD, MS, FACG; Dartmouth-Hitchcock Medical Center, Lebanon, NH
Introduction: Total pancreatectomy with islet autotransplantation (TPIAT) performed to treat painful chronic pancreatitis requires a complex islet isolation process of the explanted pancreas. Islet isolation has historically required a specialized lab to perform islet isolation. We report our experience with a novel technique of intra-operative islet isolation that does not require a specialized islet lab, thereby making the isolation process simpler, more accessible and less costly. Methods: We performed a retrospective, comparative effectiveness study of 50 adult patients who underwent TPIAT at our tertiary care center from 2012 to 2020. From 2012-15, isolation occurred at a remote location 130 miles away in which the pancreas was explanted at our center, transported to the remote islet isolation lab, and returned the same day to our center for portal vein infusion. From 2015-20, islet isolation was performed using the novel intra-operative technique at our institution without a specialized islet isolation lab. We compared the two groups with the primary outcome being islet equivalents per body weight (IE/kg), Secondary outcomes included demographics, C-peptide levels, and graft failure at one year. Results: Twenty patients underwent TPIAT with remote isolation while thirty patients underwent intra-operative isolation of islet cells. Baseline characteristics were similar between these groups (Table 1). Primary and secondary outcomes can be found in Table 2. Mean islet equivalents per kg: 4,294 (remote group) vs 3,015 (intra-op group), p=0.06. The proportion of patients with islet equivalents per kg <2000: 36.7% of intra-op patients vs 15% remote isolation patients, p=0.35. Hospital length of stay and 90 day admission rates were not statistically different between groups (p=0.44, p=0.57). Mean 1 year post-operative C-peptide levels: 1.51 ng/mL (remote group) vs 0.91 ng/mL (intra-operative group), p=0.10. The proportion of patients with 1 year post-op C-peptide levels <0.6 ng/mL: 24% in the remote group vs 42% in the intra-op group (p=0.30). Mean 1 year HA1C levels: 8.0% remote group vs 7.2% intra-op group, p=0.19. Insulin requirements at one year were not statistically different between the two groups p=0.31. Discussion: Intra-operative islet isolation has similar effectiveness in regard to glycemic outcomes compared with the use of a specialized islet cell lab. This technique should allow centers without a specialized lab to offer islet cell transplantation.
Disclosures: Christopher Navas indicated no relevant financial relationships. Kerrington Smith indicated no relevant financial relationships. Sushela Chaidarum indicated no relevant financial relationships. Timothy Gardner indicated no relevant financial relationships.