Australian experience with total pancreatectomy with islet autotransplantation to treat chronic pancreatitis

Tristan J Bampton; D Jane Holmes-Walker; Chris J Drogemuller; Toni Radford; Patricia Anderson; C Etherton; C H Russell; S Khurana; David J Torpy; J J Couper; R L T Couper; Pamela Macintyre; E L Neo; Paul Benitez-Aguirre; G Thomas; T Loudovaris; H E Thomas; Lyle J Palmer; Denghao Wu; Natasha M Rogers; L Williams; W J Hawthorne; P J O'Connell; Tom W Kay; Henry Pleass; John W Chen; P Toby Coates; Australian Islet Consortium

doi:10.1111/ans.16853

Australian experience with total pancreatectomy with islet autotransplantation to treat chronic pancreatitis

ANZ J Surg. 2021 Dec;91(12):2663-2668. doi: 10.1111/ans.16853. Epub 2021 May 6.

Authors

Tristan J Bampton^{1

2}, D Jane Holmes-Walker^{3

4}, Chris J Drogemuller², Toni Radford², Patricia Anderson⁴, C Etherton², C H Russell², S Khurana⁵, David J Torpy², J J Couper⁵, R L T Couper⁵, Pamela Macintyre², E L Neo⁶, Paul Benitez-Aguirre⁷, G Thomas^{7

8}, T Loudovaris⁹, H E Thomas⁹, Lyle J Palmer¹⁰, Denghao Wu¹, Natasha M Rogers^{4

11}, L Williams⁴, W J Hawthorne^{4

11

12}, P J O'Connell^{4

11}, Tom W Kay⁹, Henry Pleass^{4

7

11

12}, John W Chen^{2

5}, P Toby Coates^{1

2}; Australian Islet Consortium

Affiliations

¹ Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
² The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
³ Department of Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
⁵ Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
⁶ Flinders Medical Centre, Adelaide, South Australia, Australia.
⁷ Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
⁸ Westmead Children's Hospital, Sydney, New South Wales, Australia.
⁹ Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia.
¹⁰ School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
¹¹ Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
¹² Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.

PMID: 33956377
DOI: 10.1111/ans.16853

Abstract

Background: This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia.

Methods: Individuals selected for TP-IAT surgery according to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post-transplantation HbA1c, C-peptide, total daily insulin and analgesic requirement.

Results: Sixteen individuals underwent TP-IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290-7300). The median C-peptide 1 month post-TP-IAT was 384 (IQR 210-579) pmol/L and at median 29.5 (IQR 14.5-46.5) months from transplant was 395 (IQR 139-862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement.

Conclusion: The TP-IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.

Keywords: auto-islet transplantation; chronic pancreatitis; hereditary pancreatitis.

MeSH terms

Australia / epidemiology
Humans
Pain Management
Pancreatectomy*
Pancreatitis, Chronic* / surgery
Transplantation, Autologous

Grants and funding

The Hospital Research Foundation