Oral Communications 10
21.3 - NEW INDICATIONS FOR ISLET AUTOTRANSPLANTATION IN HUMAN
Presenter: Lorenzo, Piemonti, Milan, Italy
Authors: Gianpaolo Balzano1,2, Paola Maffi1,2, Rita Nano1,2, Alessandro Zerbi1,2, Massimo Venturini1,2, Raffaella Melzi1,2, Alessia Mercalli1,2, Paola Magistretti1,2, Marina Scavini1,2, Renato Castoldi1,2, Massimo Carvello1,2, Marco Braga1,2, Antonio Del Maschio1,2, Antonio Secchi1,2, Carlo Staudacher1,2, Lorenzo Piemonti1,2
NEW INDICATIONS FOR ISLET AUTOTRANSPLANTATION IN HUMAN
Gianpaolo Balzano1,2, Paola Maffi1,2, Rita Nano1,2, Alessandro Zerbi1,2, Massimo Venturini1,2, Raffaella Melzi1,2, Alessia Mercalli1,2, Paola Magistretti1,2, Marina Scavini1,2, Renato Castoldi1,2, Massimo Carvello1,2, Marco Braga1,2, Antonio Del Maschio1,2, Antonio Secchi1,2, Carlo Staudacher1,2, Lorenzo Piemonti1,2
1Diabetes Research Institute (OSR-DRI), San Raffaele Scientific Institute, Milan, Italy; 2San Raffaele Scientific Institute, Milan, Italy
Background Data. Islet autotransplantation (IAT) is performed to improve glycemic control after extended pancreatectomy, almost exclusively in patients with chronic pancreatitis. Limited experience is available for other indications or in patients with pancreatic malignancy.
Methods. In addition to chronic pancreatitis, indications for IAT were: grade C pancreatic fistula (treated with completion or left pancreatectomy, as indicated); total pancreatectomy as an alternative to high-risk anastomosis during pancreaticoduodenectomy; distal pancreatectomy for benign/borderline neoplasm of pancreatic body-neck. Malignancy was not an exclusion criterion. Metabolic and oncologic follow-up is presented.
Results. From November 2008 to June 2012, 41 patients were candidates to IAT (accounting for 7.5% of all pancreatic resections). Seven out of 41 did not received transplantation for either inadequate islet mass (4 pts), patient instability (2 pts), contamination of islet culture (1 pt). IAT-related complications occurred in 8 pts (23.5%): 4 bleeding, 3 portal thromboses (1 complete, 2 partial), 1 sepsis. Median follow-up was 546 days. Fifteen out of 34 patients (44%) reached insulin independence, 16 patients (47%) had partial graft function, 2 patients (6%) had primary graft non-function and 1 patient (3%) had early graft loss. Seventeen IAT recipients had malignancy (pancreatic or periampullary adenocarcinoma in 14). Two of them had already liver metastases at surgery, thirteen were disease-free at last follow-up and none of two patients with tumour recurrence developed metastases in the transplantation site.
Conclusions. Though larger data are needed to definitely exclude the risk of disease dissemination, the present study suggest that IAT indications can be extended to selected patients with neoplasm.