Total pancreatectomy with islet autotransplantation in diabetic and pre-diabetic patients with intractable chronic pancreatitis.

Autor:	Bachul PJ; Department of Surgery, University of Chicago, Chicago, IL, USA., Grybowski DJ; Department of Surgery, University of Chicago, Chicago, IL, USA., Anteby R; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Basto L; Department of Surgery, University of Chicago, Chicago, IL, USA., Perea L; Department of Surgery, University of Chicago, Chicago, IL, USA., Golab K; Department of Surgery, University of Chicago, Chicago, IL, USA., Wang LJ; Department of Surgery, University of Chicago, Chicago, IL, USA., Tibudan M; Department of Surgery, University of Chicago, Chicago, IL, USA., Perez-Gutierrez A; Department of Surgery, University of Chicago, Chicago, IL, USA., Komorniczak M; Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland., Nagpal S; Department of Medicine, University of Chicago, Chicago, IL, USA., Lucander A; Department of Surgery, University of Chicago, Chicago, IL, USA., Fung J; Department of Surgery, University of Chicago, Chicago, IL, USA., Matthews JB; Department of Surgery, University of Chicago, Chicago, IL, USA., Witkowski P; Department of Surgery, University of Chicago, Chicago, IL, USA.
Jazyk:	angličtina
Zdroj:	Journal of pancreatology [J Pancreatol] 2020 Jun; Vol. 3 (2), pp. 86-92.
DOI:	10.1097/jp9.0000000000000048
Abstrakt:	Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment option for non-diabetic patients with intractable chronic pancreatitis. The outcome and potential benefits for pre-diabetic and diabetic patients are less well established. Thirty-four patients underwent TPIAT were retrospectively divided into 3 groups according to pre-operative glycemic control: diabetes mellitus (DM) (n=5, 15%), pre-DM (n=11, 32%) and non-DM (n=18, 54%). Pre-operative fasting c-peptide was detectable and similar in all 3 groups. Islet yield in the DM group was comparable to pre-DM and non-DM groups (median islet equivalents [IEQ] was 191,800, 111,800, and 232,000IEQ, respectively). Patients received islet mass of over the target level of 2000IEQ/kg in pre-DM and DM at lower but clinically meaningful rates compared to the non-DM group: 45% (5/11) and 60% (3/5) for a combined 50% (8/16) rate, respectively, compared to 83% (15/18) for the non-DM group. At 1 year, fasting c-peptide and HbA1c did not differ between DM and pre-DM groups but c-peptide was significantly higher in non-DM. Islet transplantation failed (negative c-peptide) only in 1 patient. Pre-operatively, all patients experienced pancreatic pain with daily opioid dependence in 60% to 70%. Pancreatic-type pain gradually subsided completely in all groups with no differences in other painful somatic symptoms. Diabetic patients with measurable pre-operative c-peptide can achieve similar benefit from TPIAT, with comparable outcomes to pre-diabetic and non-diabetic patients including pain relief and the metabolic benefit of transplanted islets. Not surprisingly, endocrine outcomes for diabetic and pre-diabetics patients are substantially worse than in those with normal pre-operative glucose control. Competing Interests: Conflicts of interest The authors declare no conflicts of interest.
Databáze:	MEDLINE
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