title: Autotransplantation of culture-positive islet product: is dirty always bad?
abstract: BACKGROUND
  In selected patients, total pancreatectomy with islet autotransplantation (TPIAT) effectively relieves pain caused by chronic pancreatitis and ameliorates the brittle diabetes of the apancreatic state. Patients often undergo multiple endoscopic and surgical interventions prior to TPIAT, increasing the risk for pancreas colonization with enteric microorganisms. Little is known of the safety of transplanting islet cells with microbial contamination.
  
  
  METHODS
  A prospectively collected database of 80 patients submitted to TPIAT at the Medical University of South Carolina from March 2009 to February 2012 was retrospectively reviewed. Patient charts were reviewed for postoperative infectious complications and organisms identified were compared with those identified in pre-transplant islet cultures.
  
  
  RESULTS
  A total of 35 patients (43.8%) had a positive pre-transplant islet cell Gram stain or islet cell culture from the final islet preparation solution. Of these 35 patients, 33 (94.3%) were given antibiotics prophylactically post-transplant for a positive islet Gram stain or culture. Twenty patients (57.1%) receiving Gram stain- or culture-positive islets developed postoperative infectious complications, but only four patients (11.4%) developed infections that concorded with their pre-transplant islet product.
  
  
  CONCLUSIONS
  Islet transplant solutions are frequently culture-positive, presumably as a result of prior pancreas intervention. Microbial contamination of islet preparations should not preclude autotransplantation.
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Crystal N
authors.initials: CN
authors.lastname: Johnson
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Morgan
authors.forename: Stefanie M
authors.initials: SM
authors.lastname: Owczarski
authors.forename: Hongjun
authors.initials: H
authors.lastname: Wang
authors.forename: June
authors.initials: J
authors.lastname: Fried
authors.forename: David B
authors.initials: DB
authors.lastname: Adams
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D064592:Autografts; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007515:Islets of Langerhans / Q000187:drug effects / Q000382:microbiology*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000379:methods*; D010180:Pancreatectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000601:surgery*; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D013022:South Carolina; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents