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.
Sakata
Naoaki
N
Division of Hepato-Biliary Pancreatic Surgery, Department of Surgery, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai, Japan.
Egawa
Shinichi
S
Motoi
Fuyuhiko
F
Mikami
Yukio
Y
Ishida
Masaharu
M
Aoki
Takeshi
T
Ottomo
Shigeru
S
Fukuyama
Shoji
S
Rikiyama
Toshiki
T
Katayose
Yu
Y
Goto
Masafumi
M
Unno
Michiaki
M
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