Salvage Islet Auto Transplantation after Relaparatomy

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)2492-2500
Number of pages9
JournalTransplantation
Volume101
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

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Islets of Langerhans Transplantation
Pancreatectomy
Insulin
Safety
Sepsis
Hemorrhage
Transplants
Pancreaticoduodenectomy
C-Peptide
Graft Survival
Hospital Mortality
Fasting
Emergencies

ASJC Scopus subject areas

  • Transplantation

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Salvage Islet Auto Transplantation after Relaparatomy. / 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; Piemonti, Lorenzo.

In: Transplantation, Vol. 101, No. 10, 01.10.2017, p. 2492-2500.

Research output: Contribution to journalArticle

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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.",
author = "Gianpaolo Balzano and Rita Nano and Paola Maffi and Alessia Mercalli and Raffaelli Melzi and Francesca Aleotti and Francesca Gavazzi and Cesare Berra and {De Cobelli}, Francesco and Massimo Venturini and Paola Magistretti and Marina Scavini and Giovanni Capretti and {Del Maschio}, Alessandro and Antonio Secchi and Alessandro Zerbi and Massimo Falconi and Lorenzo Piemonti",
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T1 - Salvage Islet Auto Transplantation after Relaparatomy

AU - Balzano, Gianpaolo

AU - Nano, Rita

AU - Maffi, Paola

AU - Mercalli, Alessia

AU - Melzi, Raffaelli

AU - Aleotti, Francesca

AU - Gavazzi, Francesca

AU - Berra, Cesare

AU - De Cobelli, Francesco

AU - Venturini, Massimo

AU - Magistretti, Paola

AU - Scavini, Marina

AU - Capretti, Giovanni

AU - Del Maschio, Alessandro

AU - Secchi, Antonio

AU - Zerbi, Alessandro

AU - Falconi, Massimo

AU - Piemonti, Lorenzo

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

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