Anticoagulation practices in total pancreatectomy with autologous islet cell transplant patients: an international survey of clinical programs

Total pancreatectomy with autologous islet cell transplant (TPAIT) is a treatment option for patients suffering from chronic or recurrent acute pancreatitis, providing benefits of pain relief, enhanced quality of life, and prevention of brittle type 3c diabetes [1]. While surgical procedure requires extensive dissection and elevates risk of bleeding [2, 3], this operation also carries potential risk of portal venous thrombosis(0.9 to 3.4%) when impure or partially purified autologous islet preparations are infused into the portomesenteric circulation[4,5]. To mitigate the risk of thrombosis and to assist with islet engraftment by reducing Instant Blood-Mediated Inflammatory Reaction (IBMIR), anticoagulants are often utilized intra- and post-operatively [6]. Through literature review and personal communications , it is clear that different centers vary in their anticoagulation practices without any consensus guideline on the type, amount, or duration of anticoagulation, nor on the type and targets for postoperative monitoring [7]. The aim of this study is to gather information about the various anticoagulation strategies utilized by programs internationally.