title: Correlation of histopathology, islet yield, and islet graft function after islet autotransplantation in chronic pancreatitis.
abstract: OBJECTIVE
  The number of islets available (yield) is an important predictor of insulin independence after islet autotransplantation (IAT) done at the time of total pancreatectomy to treat painful chronic pancreatitis. The aim of this study was to correlate histopathologic findings with islet yield and graft function.
  
  
  METHODS
  Pancreatic histopathology was examined in 105 adults who underwent pancreatectomy and IAT; postoperative insulin use was known in 53 cases. Histologic degree of fibrosis, acinar atrophy, inflammation, and nesidioblastosis were scored by a surgical pathologist. The correlation of histopathology with islet yield and graft function was evaluated.
  
  
  RESULTS
  Patients received a median of 2968 islet equivalents per kilogram. Fibrosis and acinar atrophy correlated negatively with islet yield (P < G 0.001, r =0.67), as did inflammation (P < G 0.001, r =0.43). There was a positive correlation of islet yield (P < G 0.0001, r = 0.64) and a negative correlation of fibrosis (P = 0.006, r = 0.43) and acinar atrophy (P = 0.006, r = 0.42) with islet graft function.
  
  
  CONCLUSIONS
  More severe histopathologic changes were associated with a lower islet yield and lower likelihood of insulin independence. Total pancreatectomy and IAT should not be delayed in patients with painful chronic pancreatitis refractory to medical therapy; otherwise progressive damage to the pancreas may limit islet yield and increase the risk of diabetes.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Manivel
authors.forename: Annelisa M
authors.initials: AM
authors.lastname: Carlson
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Antoinette
authors.initials: A
authors.lastname: Moran
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Bielman
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Hering
authors.forename: Ty
authors.initials: T
authors.lastname: Dunn
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D016009:Chi-Square Distribution; D005260:Female; D005355:Fibrosis; D006085:Graft Survival; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007515:Islets of Langerhans / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D010180:Pancreatectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin