1. Salvage Islet Auto Transplantation After Relaparatomy
- Author
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Giovanni Capretti, Lorenzo Piemonti, P. Magistretti, Rita Nano, Gianpaolo Balzano, Massimo Venturini, Raffaelli Melzi, Paola Maffi, Francesca Aleotti, Francesco De Cobelli, Marina Scavini, Antonio Secchi, Alessia Mercalli, Massimo Falconi, Cesare Berra, Francesca Gavazzi, Alessandro Del Maschio, Alessandro Zerbi, Pathology/molecular and cellular medicine, Balzano, Gianpaolo, Nano, Rita, Maffi, Paola, Mercalli, Alessia, Melzi, Raffaelli, Aleotti, Francesca, Gavazzi, Francesca, Berra, Cesare, DE COBELLI, Francesco, Venturini, Massimo, Magistretti, Paola, Scavini, Marina, Capretti, Giovanni, DEL MASCHIO, Alessandro, Secchi, Antonio, Zerbi, Alessandro, Falconi, Massimo, and Piemonti, Lorenzo
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Islets of Langerhans Transplantation ,030230 surgery ,Transplantation, Autologous ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Postoperative Complications ,Pancreatitis, Chronic ,Journal Article ,Medicine ,Humans ,Aged ,Retrospective Studies ,Salvage Therapy ,geography ,Transplantation ,geography.geographical_feature_category ,business.industry ,Research Support, Non-U.S. Gov't ,Graft Survival ,Retrospective cohort study ,Middle Aged ,Pancreaticoduodenectomy ,Islet ,medicine.disease ,Surgery ,Survival Rate ,Italy ,030220 oncology & carcinogenesis ,Cohort ,Pancreatitis ,Female ,business ,Follow-Up Studies - Abstract
BACKGROUND: To assess feasibility, safety, and metabolic outcome of islet auto transplantation (IAT) in patients undergoing completion pancreatectomy because of sepsis or bleeding after pancreatic surgery. METHODS: From November 2008 to October 2016, approximately 22 patients were candidates to salvage IAT during emergency relaparotomy because of postpancreatectomy sepsis (n = 11) or bleeding (n = 11). Feasibility, efficacy, and safety of salvage IAT were compared with those documented in a cohort of 36 patients who were candidate to simultaneous IAT during nonemergency preemptive completion pancreatectomy through the pancreaticoduodenectomy. RESULTS: The percentage of candidates that received the infusion of islets was significantly lower in salvage IAT than simultaneous IAT (59.1% vs 88.9%, P = 0.008), mainly because of a higher rate of inadequate islet preparations. Even if microbial contamination of islet preparation was significantly higher in candidates to salvage IAT than in those to simultaneous IAT(78.9% vs 20%, P < 0.001), there was no evidence of a higher rate of complications related to the procedure. Median follow-up was 5.45 ± 0.52 years. Four (36%) of 11 patients reached insulin independence, 6 patients (56%) had partial graft function, and 1 patient (9%) had primary graft nonfunction. At the last follow-up visit, median fasting C-peptide was 0.43 (0.19-0.93) ng/mL; median insulin requirement was 0.38 (0.04-0.5) U/kg per day, and median HbA1c was 6.6% (5.9%-8.1%). Overall mortality, in-hospital mortality, metabolic outcome, graft survival, and insulin-free survival after salvage IAT were not different from those documented after simultaneous IAT. CONCLUSIONS: Our data demonstrate the feasibility, efficacy, and safety of salvage IAT after relaparotomy.
- Published
- 2017