P-180

Autologous pancreatic islet transplantation (IAT) as endocrine tissue rescue in patients undergoing completion pancreatectomy because of surgical complication after whipple resection

G. Balzano, P. Maffi, R. Nano, R. Melzi, A. Mercalli, C. Ridolfi, F. Merlini, P. Magistratti, A. Secchi, V. Di Carlo, L. Piemonti
San Raffaele Scientific Institute, San Raffaele Diabetes Research Institute, Milan, Italy

Objective: We tested the safety and feasibility of IAT in patients (pts) undergoing completion pancreatectomy because of anastomosis leakage after pancreatoduodenectomy for nonmalignant or malignant diseases.

Method: Between November 2008 and September 2010, 8 pts were recruited (4M/4F, age 52±17 yrs). Six of 8 were cancer-bearing pts (#1 and #7 Vater's papilla carcinomas; #2 neuroendocrine carcinoma of ampulla; #3 focal chronic pancreatitis; #4 ductal carcinoma; #5 and #6 common bile duct carcinomas; #8 pseudopapillary solid tumor). Total pancreatectomy (#8 subtotal) was performed 18±9 days after Whipple resection because of anastomosis leakage conditioning massive bleeding (2/6) or septic shock (2/8). Islets were obtained and purified by the pancreatic remnant (64±18g) as for allogenic transplantation.

Results: Isolation was possible in 7/8 pts (#5 failed for pancreas caseous necrosis). Mean islet yield was 2,746±957 IEQ/g of tissue, resulting in transplantation of 1,966±1,090 IEQ/kg body weight. Islets were transplanted within 24h by percutaneous transhepatic intraportal infusion (#1 by cannulating portal vein during completion pancreatectomy). Due to the presence of preexisting portal thrombosis, islets were infused into iliac crest in #3. Three pts had IAT-related complications solved without any intervention including portal vein thrombosis (#1, #4) and perihepatic hematoma (#2). Patient #3 died at day 5 for IAT unrelated fatal bleeding. All the other patients are still alive and the median follow-up is 299 days. Pts #2 (2,157 IEQ/kg) and #8 (4,570 IEQ/kg) gained (at day +118 and +1) and maintained insulin free regimen until last observation (day +746 and +154). Pts #1, #4, #6, #7 showed transplant partial function. At six month follow up C-peptide, insulin requirement and HbA1c were 0.86±0.66ng/ml, 0.27±0.19UI/kg/day and 7.2±0.6%, respectively. No symptomatic hypoglycemia or hepatic recurrences of pancreatic disease were recorded during the follow-up.

Conclusion: IAT is a safe and feasible procedure to improve glycemic control after completion pancreatectomy.

P-180

Autologous pancreatic islet transplantation (IAT) as endocrine tissue rescue in patients undergoing completion pancreatectomy because of surgical complication after whipple resection

G. Balzano, P. Maffi, R. Nano, R. Melzi, A. Mercalli, C. Ridolfi, F. Merlini, P. Magistratti, A. Secchi, V. Di Carlo, L. Piemonti
San Raffaele Scientific Institute, San Raffaele Diabetes Research Institute, Milan, Italy

Objective: We tested the safety and feasibility of IAT in patients (pts) undergoing completion pancreatectomy because of anastomosis leakage after pancreatoduodenectomy for nonmalignant or malignant diseases.

Method: Between November 2008 and September 2010, 8 pts were recruited (4M/4F, age 52±17 yrs). Six of 8 were cancer-bearing pts (#1 and #7 Vater's papilla carcinomas; #2 neuroendocrine carcinoma of ampulla; #3 focal chronic pancreatitis; #4 ductal carcinoma; #5 and #6 common bile duct carcinomas; #8 pseudopapillary solid tumor). Total pancreatectomy (#8 subtotal) was performed 18±9 days after Whipple resection because of anastomosis leakage conditioning massive bleeding (2/6) or septic shock (2/8). Islets were obtained and purified by the pancreatic remnant (64±18g) as for allogenic transplantation.

Results: Isolation was possible in 7/8 pts (#5 failed for pancreas caseous necrosis). Mean islet yield was 2,746±957 IEQ/g of tissue, resulting in transplantation of 1,966±1,090 IEQ/kg body weight. Islets were transplanted within 24h by percutaneous transhepatic intraportal infusion (#1 by cannulating portal vein during completion pancreatectomy). Due to the presence of preexisting portal thrombosis, islets were infused into iliac crest in #3. Three pts had IAT-related complications solved without any intervention including portal vein thrombosis (#1, #4) and perihepatic hematoma (#2). Patient #3 died at day 5 for IAT unrelated fatal bleeding. All the other patients are still alive and the median follow-up is 299 days. Pts #2 (2,157 IEQ/kg) and #8 (4,570 IEQ/kg) gained (at day +118 and +1) and maintained insulin free regimen until last observation (day +746 and +154). Pts #1, #4, #6, #7 showed transplant partial function. At six month follow up C-peptide, insulin requirement and HbA1c were 0.86±0.66ng/ml, 0.27±0.19UI/kg/day and 7.2±0.6%, respectively. No symptomatic hypoglycemia or hepatic recurrences of pancreatic disease were recorded during the follow-up.

Conclusion: IAT is a safe and feasible procedure to improve glycemic control after completion pancreatectomy.