Outcome after total pancreatectomy with islet autotransplantation: A European single-center study

Klara Fröberg; Asif Halimi; Miroslav Vujasinovic; José Caballero-Corbalan; Urban Arnelo; Ernesto Sparrelid; Olle Korsgren; Johannes-Matthias Löhr; Torbjörn Lundgren; Poya Ghorbani

doi:10.1177/14574969231220176

Outcome after total pancreatectomy with islet autotransplantation: A European single-center study

Scand J Surg. 2023 Dec 25:14574969231220176. doi: 10.1177/14574969231220176. Online ahead of print.

Authors

Klara Fröberg¹, Asif Halimi^{2

3}, Miroslav Vujasinovic^{2

4}, José Caballero-Corbalan⁵, Urban Arnelo^{2

3}, Ernesto Sparrelid^{2

4}, Olle Korsgren⁶, Johannes-Matthias Löhr^{2

4}, Torbjörn Lundgren⁷, Poya Ghorbani¹

Affiliations

¹ Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Disease, Karolinska University Hospital, 14186 Stockholm, Sweden.
² Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden.
³ Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
⁴ Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁵ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁶ Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
⁷ Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden.

PMID: 38145318
DOI: 10.1177/14574969231220176

Abstract

Background and aims: Chronic pancreatitis may cause intractable abdominal pain, with total pancreatectomy sometimes being the last resort. To mitigate the subsequent diabetes, total pancreatectomy can be followed by islet autotransplantation (TP-IAT). The primary aim of this study was to assess the outcomes in patients undergoing TP-IAT at Karolinska University Hospital with respect to safety, postoperative complications, and islet graft function. A secondary aim was to compare liver to skeletal muscle as autotransplantation sites.

Methods: Single-center observational cohort study on patients undergoing TP-IAT. Islets were transplanted either into the liver or skeletal muscle. Data on baseline characteristics and pretransplantory conditions were collected. Outcome measures included mortality and major postoperative complications as well as the glycemic measures: insulin use, fasting C-peptide, and HbA1c.

Results: Between 2004 and 2020, 24 patients underwent TP-IAT. Islets were transplanted into the liver in 9 patients and into skeletal muscle in 15 patients. There was no 90-day mortality, and major complications (Clavien-Dindo ⩾IIIa) occurred in 26.7%, all related to the procedure of total pancreatectomy. Fasting C-peptide could be detected postoperatively, with higher levels in patients receiving islet autotransplantation into the liver (p = 0.006). Insulin independence was not achieved, although insulin doses at last follow-up were significantly lower in patients receiving islet autotransplantation into the liver compared to skeletal muscle (p = 0.036).

Conclusion: TP-IAT is safe and associated with tolerable risk, the component of islet autotransplantation being seemingly harmless. Although islet grafts maintain some endocrine function, insulin independence should not be expected. Regarding islet autotransplantation sites, the liver seems superior to skeletal muscle.

Clinical trial registration: Not applicable.

Keywords: Chronic pancreatitis; TP-IAT; islet autotransplantation; total pancreatectomy; total pancreatectomy with islet autotransplantation.