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Case Reports
. 2018 Oct;27(10):1561-1568.
doi: 10.1177/0963689718798627. Epub 2018 Sep 14.

Omental Pouch Technique for Combined Site Islet Autotransplantation Following Total Pancreatectomy

Mark J Stice  1 , Ty B Dunn  1 , Melena D Bellin  2 , Mariya E Skube  1 , Greg J Beilman  1
Affiliations
Case Reports

Omental Pouch Technique for Combined Site Islet Autotransplantation Following Total Pancreatectomy

Mark J Stice et al. Cell Transplant. 2018 Oct.

Abstract

Total pancreatectomy and islet autotransplantation (TPIAT) is an effective treatment for selected patients with chronic pancreatitis. The portal circulation is the standard infusion site for islet transplant, but marked elevation of portal pressures may prevent complete islet infusion. Herein we report a novel technique of combined site islet autotransplantation using an omental pouch. This technique may be useful when technical limitations prevent complete intraportal transplantation. In four TPIAT recipients with intraoperative issues precluding the complete intraportal infusion of islets, an omental pouch was created to contain the remaining islet mass. Patients were monitored for complications, and islet graft function was assessed using mixed meal tolerance testing and compared with matched controls who received only intraportally transplanted islets. All patients had decreasing insulin requirements as their recovery progressed. At 3 months follow-up there were no significant differences in glycemic control or graft function for the combined site recipients compared with their matched controls who only received an intraportal islet infusion. The omentum has potentially desirable qualities such as accessibility, capacity, and systemic/portal vascularity comparable to the native pancreas. The omental pouch technique may represent a safe and effective alternate site for islet autotransplantation. Further study is needed to confirm these findings.

Keywords: chronic pancreatitis; extrahepatic islet autotransplantation; islet autotransplantation; omental pouch; total pancreatectomy islet autotransplantation.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Omental pouch creation. (a) Pouch is created by lifting up edges of omentum. The concentrated islet preparation is dripped on to the omentum and affixed using a fibrin sealant hemostatic agent. (b) After islets have been affixed with the hemostatic agent, the pouch is sealed with a running 3-0 Vicryl suture.
Figure 2.
Figure 2.
Comparison of pre-TPIAT and 3-month follow-up glycemic function in omental pouch recipients and their matched controls. Histogram bars represent mean pooled values for all patients in a respective group. Error bars show a single standard deviation. (a) 120 minute glucose results. No significant differences between groups. (b) Peak C-peptide, represented by maximum C-peptide value obtained during MMTT. No significant differences between groups.
See this image and copyright information in PMC

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