Institutional indications for islet transplantation after total pancreatectomy.
OBJECTIVE
This study was designed to establish institutional indications for pancreatic islet transplantation by examining patients with total pancreatectomy as candidates for islet allotransplantation.


METHODS
In 12 patients who underwent total pancreatectomy, we compared pre-and postoperative plasma glucose level, body mass index, HbA1c, and daily insulin use; we examined candidacy for islet allotransplantation based on the guidelines of Japan's islet transplantation registry.


RESULTS
Eight of the 12 patients with total pancreatectomy were operated for intraductal papillary mucinous neoplasm. At our institution, the 5-year survival of patients with intraductal papillary mucinous neoplasm was far better (76.3%) than that of patients with pancreatic cancer. Postoperatively, plasma glucose level, HbA1c, and daily insulin use were increased in all patients with total pancreatectomy. Of the 12 patients treated with total pancreatectomy, 4 (intraductal papillary mucinous neoplasm, n = 2; islet cell tumor, n = 1; and acute pancreatitis due to arteriovenous malformation, n = 1) showed deteriorated diabetic control and therefore were considered to be candidates for islet allotransplantation according to the guidelines.


CONCLUSIONS
Islet allotransplantation could be indicated for patients with favorable postoperative survival who have had a total pancreatectomy for either benign or neoplastic disease.
Division of Hepato-Biliary Pancreatic Surgery, Department of Surgery, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, Japan.
Naoaki
N
Sakata
Shinichi
S
Egawa
Fuyuhiko
F
Motoi
Yukio
Y
Mikami
Masaharu
M
Ishida
Takeshi
T
Aoki
Shigeru
S
Ottomo
Shoji
S
Fukuyama
Toshiki
T
Rikiyama
Yu
Y
Katayose
Masafumi
M
Goto
Michiaki
M
Unno
D000368:Aged; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016381:Islets of Langerhans Transplantation; D007564:Japan; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D014184:Transplantation, Homologous