title: Current principles and practice in autologous intraportal islet transplantation: a meta-analysis of the technical considerations.
abstract: OBJECTIVE
  Autologous islet transplantation (IAT) following pancreatectomy is now a recognized, albeit highly specialized procedure carried out in a small number of centers worldwide. Current clinical principles and best practice with emphasis on examining the technical aspects of surgery in centers with significant IAT experience are reviewed.
  
  
  METHODS
  Literature search for studies discussing any technical aspect of pancreatectomy with intraportal IAT was included.
  
  
  RESULTS
  Thirty-five papers were included; all were single-center case series. The indications, surgical approach to pancreatectomy with IAT, islet yield, static pancreas preservation prior to islet digestion, portal vein access, absolute islet infusion volumes, and portal venous pressure changes during transfusion evaluated.
  
  
  CONCLUSIONS
  IAT is considered a "last resort" when alternative approaches have been exhausted. Pre-morbid histology and prior surgical drainage adversely influence islet yields and may influence the clinical decision to perform pancreatectomy and IAT. Following pancreas digestion, absolute numbers of islets recovered and smaller islet size predict rates of insulin independence following IAT. Islet volumes and portal venous pressure changes are important factors for the development of complications. Surgical access for IAT includes intra-operative, immediate or delayed infusion via an "exteriorized" vein, and radiological percutaneous approaches. Delayed infusion can be combined with pancreas preservation techniques prior to islet isolation.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
authors.forename: Rohan
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
authors.forename: Wen Yuan
authors.initials: WY
authors.lastname: Chung
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
authors.forename: Ashley Robert
authors.initials: AR
authors.lastname: Dennison
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
mesh_terms: D006801:Humans; D016381:Islets of Langerhans Transplantation; D010182:Pancreatic Diseases / Q000517:prevention & control*; D011379:Prognosis; D014182:Transplantation, Autologous
keywords: autologous islet transplantation; chronic pancreatitis; intraportal islet transfusion/transplantation; islet isolation techniques; islet yield optimization; surgical diabetes