Islet autotransplantation after complete rescue pancreatectomy for complications of upper GI-tract surgery

This is the authors' abstract. We don't add key points for this paper.

Introduction: Anastomotic insufficiency after upper gastrointestinal tract surgery is associated with high morbidity and mortality. Complete pancreatectomy is representing a bail out procedure if major complications at a pancreatojejunostomy or duodenal anastomosis occured or will be expected and the patient is in a condition that does not allow for drainage or reanastomosis. Such a procedure leads to complete endo- and exocrine deficiency. Due to the lack of the insulin counter player glucagon such a state can be associated with live threatening hypoglycemia. Islet autotransplantation is a method to restore glycemic control avoiding immunosuppression. Methods: Following complete or subtotal pancreatectomy in 6 patients islets were isolated using a modified Ricordi-method. After completion of the isolation process the islets were transplanted into the liver via open surgery through a portal vein catheter infusion. Glucose, insulin and C-peptide levels were used for metabolic monitoring after autotransplantation. Result: 8 patients were autotransplanted with an average of 180.000 IEQ (110.000 – 220.000 IEQ). The autotransplantation procedure was performed without complications. 2/8 patients died during hospital stay due to septic complications with functioning autografts. 2/8 patients had a prolonged stay because of relaparotomies. The remaining two patients were treated without complications. All patients showed good primary and mid-term function of the islets. Conclusion: Islet autotransplantation is an effective tool in the treatment of pancreatectomized patients to avoid long term complications of pancreoprive diabetes.