title: Pancreatic islet autotransplantation after completion pancreatectomy for pancreatic fistula after hemipancreatoduodenectomy for carcinoma.
abstract: OBJECTIVE
  Pancreatic islet autotransplantation (IAT) has a potential to prevent brittle diabetes in patients after total pancreatectomy. Because of the fear of tumor spread, IAT has rarely been used in case of malignancy. We report our experience with patients who underwent hemipancreatoduodenectomy for carcinoma and later completion pancreatectomy for pancreatic fistula with islet autotransplantation at our institution.
  
  
  METHODS
  From August 2007 to December 2012, 5 patients underwent IAT after completion pancreatectomy for pancreatic fistula after hemipancreatoduodenectomy for carcinoma. Islets were isolated from the pancreatic tail with the use of digestion with collagenase. Nonpurified islet suspension was infused into the portal vein during surgery.
  
  
  RESULTS
  The median number of islets transplanted was 175,000 islet equivalents (range, 70,000-365,000). One patient died after surgery for reasons unrelated to IAT. Another 3 patients had stable diabetes with partial graft function (fasting C-peptide levels 0.23, 0.41, and 0.61 nmol/L and HbA1c 4.8%, 4.6%, and 6.9% at 24, 24 and 9 months after IAT, respectively). The 1st patient, with pancreatic head carcinoma, was alive 28 months after IAT with lymph node and liver recurrence since 18 months after IAT. The 2nd patient, with gall bladder and distal bile duct carcinoma, died 47 months after IAT with tumor recurrence. The 3rd patient, with ampullary carcinoma, died 12 months after IAT with local recurrence and solitary liver metastasis. The last patient had been off insulin 9 months after IAT without tumor recurrence (fasting C-peptide, 0.89 nmol/L; HbA1c, 4.2%).
  
  
  CONCLUSIONS
  Autotransplantation of pancreatic islets isolated from the residual pancreatic tissue in patients who previously underwent hemipancreatoduodenectomy for cancer may provide stable glucose control and thus improve quality of life. In this small series we did not observe early development of multiple liver metastases caused by islet suspension contamination with malignant cells. Oncologic outcome of the patients was not worse than what would be expected without IAT.
authors.affiliation: Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Electronic address: matej.kocik@ikem.cz.
authors.forename: M
authors.initials: M
authors.lastname: Kocik
authors.affiliation: Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: K
authors.initials: K
authors.lastname: Lipar
authors.affiliation: Department of Diabetes, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: F
authors.initials: F
authors.lastname: Saudek
authors.affiliation: Department of Diabetes, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Girman
authors.affiliation: Department of Diabetes, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Boucek
authors.affiliation: Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Kucera
authors.affiliation: Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Fronek
authors.affiliation: Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Oliverius
mesh_terms: D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D014182:Transplantation, Autologous; D016896:Treatment Outcome