Assessment of long-term graft function following total pancreatectomy and autologous islet transplantation: the Leicester experience
Pollard, Christina A Chung, Wen Yuan Garcia, Guiseppe Dennison, Ashley R
Pollard, Christina A
Chung, Wen Yuan
Garcia, Guiseppe
Dennison, Ashley R
Abstract
Background: Total pancreatectomy and islet autotransplantation (TPIAT) is a recognised treatment for chronic pancreatitis (CP) with the potential to mitigate or prevent pancreatogenic diabetes. We present our 10-year follow-up of TPIAT patients.
Methods: The University Hospitals of Leicester performed 60 TPIAT procedures from September 1994 to May 2011. Seventeen patients completed their 10-year assessment and were grouped using the modified Auto-Igls criteria; good response, n=5 (insulin-independent for first 5 years post-TPIAT); partial response, n=6 (insulin requirements <20 iU/day post-TPIAT) and poor response, n=6 (insulin requirements ≥20 iU/day post-TPIAT). C-peptide, haemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were undertaken preoperatively (baseline), then at 3, 6 months and then yearly for 10 years. Data was analysed using analysis of variance (ANOVA).
Results: Median C-peptide levels were significantly higher, 120 minutes following OGTT, in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0001). All groups demonstrated preservation of C-peptide release. HbA1c levels were significantly lower in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0003 and P<0.0001). Median fasting glucose levels at 30 and 120 min following OGTT, were significantly lower in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0001 and P<0.0001).
Conclusions: TPIAT preserves long-term islet graft functions in 10-year follow up. Even in patients in the poor response group, there is evidence of C-peptide release (>0.5 ng/mL) after OGTT stimulation potentially preventing long-term diabetes-related complications.
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Date
2023-10-01
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Pollard, C. A., Chung, W. Y., Garcea, G., & Dennison, A. R. (2023). Assessment of long-term graft function following total pancreatectomy and autologous islet transplantation: the Leicester experience. Hepatobiliary surgery and nutrition, 12(5), 682–691. https://doi.org/10.21037/hbsn-21-558