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

• 作者: Anteby Roi Bachul Piotr J. Basto Lindsay Fung John Golab Karolina Grybowski Damian J. Gutierrez Angelica P. Komorniczak Michal Lucander Aaron Matthews Jeffrey B. Nagpal Sajan Perea Laurencia Tibudan Martin Wang Ling-Jia Witkowski Piotr
• 来源期刊: 胰腺病学杂志（英文）
• 关键词: Autotransplantation Islets Outcomes Pancreatectomy Pre-diabetes
• 年，卷（期）: 2020,（2）
• 所属期刊栏目: Original Article
• 页码范围: 86-92
• 页数: 7页
• 语种: 中文
• DOI: 10.1097/JP9.0000000000000048

摘要

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 232,000 IEQ, respectively). Patients received islet mass of over the target level of 2000 IEQ/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. Preoperatively, 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 prediabetics patients are substantially worse than in those with normal pre-operative glucose control.