title: Factors associated with islet yield and insulin independence after total pancreatectomy and islet cell autotransplantation in patients with chronic pancreatitis utilizing off-site islet isolation: Cleveland Clinic experience.
abstract: BACKGROUND
  Total pancreatectomy (TP) with islet cell autotransplantation (IAT) can reduce or prevent diabetes by preserving beta cell function and is normally performed with on-site isolation laboratory facilities.
  
  
  OBJECTIVE
  We examined factors associated with islet yield and metabolic outcomes in patients with chronic pancreatitis undergoing TP-IAT. We report our experience of TP-IAT with an off-site islet isolation laboratory.
  
  
  METHODS
  Data (August 2008 to February 2014) were obtained from a TP-IAT database which included information from medical records, clinic visits, questionnaires, and follow-up telephone calls. Each patient was assessed with pre- and postoperative 5-hour mixed-meal tolerance tests for metabolic measurements and with serial glycosylated hemoglobin (HbA1c) determinations.
  
  
  RESULTS
  Thirty-six patients with a mean age of 38 years (range, 16-72 y) underwent TP-IAT for different etiologies. At a median follow-up time of 28 months (range, 3-66 mo), 12 patients were insulin independent and 24 patients were on at least one insulin injection a day. Postoperatively, C-peptide levels ≥0.3 ng/mL were present in 23/33 (70%) of the patients, with a median fasting C-peptide value of 0.8 ng/mL (range, <0.2-1.5 ng/mL). Those who were insulin independent were more likely to be female (P = .012), have normal morphology on pre-operative pancreatic imaging (P = .011), and have significantly higher median islet yield (6845 islet equivalent numbers [IEQ]/kg, n = 12 vs 3333 IEQ/kg, n = 24; P < .001).
  
  
  CONCLUSIONS
  IAT after TP performed in our facility with an off-site islet isolation laboratory shows islet yield and rates of insulin independence that are comparable to other large centers with on-site laboratories.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism (P.C.J., Y.K.L., C.F., B.A.H.), and Department of General Surgery, Digestive Disease Institute (R.M.W.), Cleveland Clinic, Cleveland, Ohio, 44195; Department of Pediatrics (R.B., M.T.), Division of Immunogenetics, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; and Department of Gastroenterology and Hepatology, Digestive Disease Institute (T.K.S.), and Department of Biostatistics, Quantitative Health Sciences (J.B.), Cleveland Clinic, Cleveland, Ohio, 44195.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Johnston
authors.forename: Yu Kuei
authors.initials: YK
authors.lastname: Lin
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Rita
authors.initials: R
authors.lastname: Bottino
authors.forename: Tyler K
authors.initials: TK
authors.lastname: Stevens
authors.forename: Massimo
authors.initials: M
authors.lastname: Trucco
authors.forename: James
authors.initials: J
authors.lastname: Bena
authors.forename: Charles
authors.initials: C
authors.lastname: Faiman
authors.forename: Betul A
authors.initials: BA
authors.lastname: Hatipoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D055815:Young Adult