title: Extending indications for islet autotransplantation in pancreatic surgery.
abstract: OBJECTIVE
  To assess metabolic and oncologic outcomes of islet autotransplantation (IAT) in patients undergoing pancreatic surgery for either benign or malignant disease.
  
  
  BACKGROUND
  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; and 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 of 41 did not receive transplantation for inadequate islet mass (4 pts), patient instability (2 pts), or contamination of islet culture (1 pt). IAT-related complications occurred in 8 pts (23.5%): 4 bleeding, 3 portal thromboses (1 complete, 2 partial), and 1 sepsis. Median follow-up was 546 days. Fifteen of 34 patients (44%) reached insulin independence, 16 patients (47%) had partial graft function, 2 patients (6%) had primary graft nonfunction, 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, 13 were disease-free at last follow-up, and none of 2 patients with tumor recurrence developed metastases in the transplantation site.
  
  
  CONCLUSIONS
  Although larger data are needed to definitely exclude the risk of disease dissemination, the present study suggests that IAT indications can be extended to selected patients with neoplasm.
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Paola
authors.initials: P
authors.lastname: Maffi
authors.forename: Rita
authors.initials: R
authors.lastname: Nano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.forename: Raffaella
authors.initials: R
authors.lastname: Melzi
authors.forename: Alessia
authors.initials: A
authors.lastname: Mercalli
authors.forename: Paola
authors.initials: P
authors.lastname: Magistretti
authors.forename: Marina
authors.initials: M
authors.lastname: Scavini
authors.forename: Renato
authors.initials: R
authors.lastname: Castoldi
authors.forename: Michele
authors.initials: M
authors.lastname: Carvello
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
authors.forename: Antonio
authors.initials: A
authors.lastname: Secchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Staudacher
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Piemonti
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D010185:Pancreatic Fistula / Q000401:mortality / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome