2011 - IPITA - Prague


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Parallel session 6 – Open mini-oral presentations Topic: Clinical and experimental islet transplantation

6.2 - Autologous pancreatic islet transplantation (IAT) as endocrine tissue rescue in patients with technically unfeasible or high risk pancreatic anastomosis during partial pancreatectomy

Presenter: L., Piemonti, Milan, Italy
Authors: G. Balzano, P. Maffi, R. Nano, R. Melzi, A. Mercalli, C. Ridolfi, F. Merlini, P. Magistretti, A. Secchi, V. Di Carlo, L. Piemonti


Autologous pancreatic islet transplantation (IAT) as endocrine tissue rescue in patients with technically unfeasible or high risk pancreatic anastomosis during partial pancreatectomy

G. Balzano, P. Maffi, R. Nano, R. Melzi, A. Mercalli, C. Ridolfi, F. Merlini, P. Magistretti, 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 pancreatoduodenectomy or median pancreatectomy in which pancreatic anastomosis was made impracticable by technical difficulties and/or high risk of leakage.

Method: Between November 2008 and February 2011 9 pts were recruited (4M/5F, age 61±10 yrs). Six of 9 were cancer-bearing pts (#1, #4 and #9 neuroendocrine tumors; #2 duodenal carcinoma; #3, #6 and #7 ductal carcinomas, #5 and #8 neuroendocrine carcinomas). Total (7/9) or subtotal (2/9; #1, #4) pancreatectomies were performed because of technical difficulties (6/9) or high risk of leakage (3/9). Islets were obtained and purified by the pancreatic remnant (55±31g) as for allogenic transplantation.

Results: Isolation was possible in all pts. Mean islet yield was 3,221±1685 IEQ/g of tissue, resulting in transplantation of 2,474±1,377 IEQ/kg body weight. Islets were transplanted within 24h by percutaneous transhepatic intraportal infusion (#1, #2, #4, #5, #7) or by cannulating portal vein during pancreatectomy (#9). Due to contraindications for intra liver infusion, islets were transplanted into iliac crest in #3, #6 and #8. No IAT-related complications were observed. Patient #2 died at day 501 for progression of metastatic malignant disease already present at the time of IAT. All the other patients are still alive and the median follow-up is 257 days. Pts #1 (2,263 IEQ/kg), #2 (3,952 IEQ/kg), #4 (3,119 IEQ/kg) and # 6 gained insulin free regimen (IF) at day +30, +60, +7 and +7, respectively. Pts #3 (667 IEQ/kg), #5 (628 IEQ/kg), #7 (1,890 IEQ/kg), #8 (2812 IEQ/kg), #9 (2164 IEQ/kg) showed transplant partial function. At last follow up C-peptide, insulin requirement and glycated haemoglobin were 0.6±0.24ng/ml, 0.51±0.14UI/kg/day and 6.8±0.3%, respectively. No hepatic recurrences of pancreatic disease were recorded during the follow-up.

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


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