P-221

Successful islet autotransplantation under severe inflammatory status due to a rupture of the pancreatic arteriovenous malformation by introducing a novel graft protecting protocol

M. Goto¹, N. Sakata², H. Yamaya³, F. Motoi², S. Yamaguchi⁴, T. Imura¹, A. Inagaki¹, T. Ito⁵, H. Hayashi², Y. Ishigaki⁴, H. Katagiri⁴, Y. Hasegawa⁴, S. Sawada⁴, M. Hirota⁶, T. Shimosegawa⁶, S. Sekiguchi³, K. Fujimori³, S. Egawa², M. Unno², S. Satomi^3
1 Tohoku University, New Industry Creation Hatchery Center, Sendai, Japan; ² Division of Hepato-Biliary Pancreatic Surgery, Tohoku University, Sendai, Japan; ³ Division of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan; ⁴ Department of Diabetes and Metabolism, Tohoku University, Sendai, Japan; ⁵ Innovation of New Biomedical Engineering Center, Tohoku University, Sendai, Japan; ⁶ Division of Gastroenterology, Tohoku University, Sendai, Japan

Objective: Under severe inflammatory status, isletautotransplantation usually fails due to insufficientislet yield and impaired islet quality. In the present study, we haveintroduced a novel graft protecting protocol to the clinical isletautotransplantation, and evaluated islet engraftment.

Methods: The emergent totalpancreatectomy and islet autotransplantation were performed to a 59-year-oldman diagnosed with a pancreatic arteriovenous malformation due to a rupture ofthe mass. The pancreas weight was 54 g and cold ischemic time was 74 minutes.The pancreatic islets were isolated using a modified Ricordi method. Inhalationof isoflurane during islet infusion and continuous intensive insulin treatmentcombined with short-term fasting/total parenteral nutrition during avascularperiod of the grafts (10 days) were introduced to rest the islet grafts.

Results: The islet yieldwas 355,270 islet equivalents and total tissue volume was 5.7 ml. Aftercertifying there was no bacterial contamination, the islets were transplantedvia portal vein. The increase of portal vein pressure was mild duringtransplantation (max 13 mmHg). The blood glucose of the recipient was wellmaintained between 80-150 mg/dl with no sign of hypoglycemia, and there was asufficient level of fasting C-peptide (>0.5ng/mL), and a low dose of dailyinsulin at 5 months after transplantation. The SUIT index at 90 days aftertransplantation reached 27, suggesting that potency of the transplanted graftsmay be close to insulin-off state. Notably, the glucose tolerance test at 60days after transplantation revealed stable glucose change (Max 167 mg/dl) and asufficient secretion of C-peptide (Basal: 0.16 ng/ml, Max: 4.29 ng/ml)

Conclusions: These datasuggest that refined islet isolation procedures combined with a novel graftprotecting protocol could be of great importance for successful isletautotransplantation under severe inflammatory status.

P-221

Successful islet autotransplantation under severe inflammatory status due to a rupture of the pancreatic arteriovenous malformation by introducing a novel graft protecting protocol

M. Goto¹, N. Sakata², H. Yamaya³, F. Motoi², S. Yamaguchi⁴, T. Imura¹, A. Inagaki¹, T. Ito⁵, H. Hayashi², Y. Ishigaki⁴, H. Katagiri⁴, Y. Hasegawa⁴, S. Sawada⁴, M. Hirota⁶, T. Shimosegawa⁶, S. Sekiguchi³, K. Fujimori³, S. Egawa², M. Unno², S. Satomi^3
1 Tohoku University, New Industry Creation Hatchery Center, Sendai, Japan; ² Division of Hepato-Biliary Pancreatic Surgery, Tohoku University, Sendai, Japan; ³ Division of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan; ⁴ Department of Diabetes and Metabolism, Tohoku University, Sendai, Japan; ⁵ Innovation of New Biomedical Engineering Center, Tohoku University, Sendai, Japan; ⁶ Division of Gastroenterology, Tohoku University, Sendai, Japan

Objective: Under severe inflammatory status, isletautotransplantation usually fails due to insufficientislet yield and impaired islet quality. In the present study, we haveintroduced a novel graft protecting protocol to the clinical isletautotransplantation, and evaluated islet engraftment.

Methods: The emergent totalpancreatectomy and islet autotransplantation were performed to a 59-year-oldman diagnosed with a pancreatic arteriovenous malformation due to a rupture ofthe mass. The pancreas weight was 54 g and cold ischemic time was 74 minutes.The pancreatic islets were isolated using a modified Ricordi method. Inhalationof isoflurane during islet infusion and continuous intensive insulin treatmentcombined with short-term fasting/total parenteral nutrition during avascularperiod of the grafts (10 days) were introduced to rest the islet grafts.

Results: The islet yieldwas 355,270 islet equivalents and total tissue volume was 5.7 ml. Aftercertifying there was no bacterial contamination, the islets were transplantedvia portal vein. The increase of portal vein pressure was mild duringtransplantation (max 13 mmHg). The blood glucose of the recipient was wellmaintained between 80-150 mg/dl with no sign of hypoglycemia, and there was asufficient level of fasting C-peptide (>0.5ng/mL), and a low dose of dailyinsulin at 5 months after transplantation. The SUIT index at 90 days aftertransplantation reached 27, suggesting that potency of the transplanted graftsmay be close to insulin-off state. Notably, the glucose tolerance test at 60days after transplantation revealed stable glucose change (Max 167 mg/dl) and asufficient secretion of C-peptide (Basal: 0.16 ng/ml, Max: 4.29 ng/ml)

Conclusions: These datasuggest that refined islet isolation procedures combined with a novel graftprotecting protocol could be of great importance for successful isletautotransplantation under severe inflammatory status.