Islet Cell Yield Following Remote Total Pancreatectomy With Islet Autotransplant is Independent of Cold Ischemia Time

Abstract

Objectives: Total pancreatectomy with islet autotransplantation is increasingly being performed remotely, that is, removing the pancreas in 1 location, isolating the islet cells in another location, then returning the islets to the original location for reimplantation into the patient. We determined the influence of extended cold ischemia time on key clinical outcomes in remote islet autotransplantation.

Methods: We evaluated patients who underwent remote islet autotransplantation at 2 centers from 2011 to 2014. Patients were divided into 2 groups: those with and those without a decrease in C-peptide greater than 50% from baseline. The primary clinical outcome was the quantity of isolated islet equivalents per kilogram body weight (IEQs/kg).

Results: Twenty-five patients met inclusion criteria; 15 had a decrease in C-peptide greater than 50% from baseline and had lower corresponding IEQs/kg compared with those without a decrease greater than 50% (4045 vs 6654 IEQs/kg, P = 0.01). There was no difference in cold ischemia time between the 2 groups (664 vs 600 minutes, P = 0.25). Daily insulin use at 1 year nearly met statistical significance (25.3 vs 8 U, P = 0.06), as did glycated hemoglobin (8.07 vs 6.69 mmol/L, P = 0.06).

Conclusions: Cold ischemia time does not influence islet yield in patients undergoing pancreatectomy with remote isolation.

Figure 1

The Remote TP-IAT process with definition of isolation stages

Figure 2

Isolated IEQ/Kg based on 1-year c-peptide

Figure 3

Linear Regression: percent change c-peptide vs. total cold ischemia time

Figure 4

Clinical outcomes based on 1-year c-peptide. Insulin, U=Mean daily number of units of insulin used. MME=Morphine equivalents/day.