title: Microbial contamination of transplant solutions during pancreatic islet autotransplants is not associated with clinical infection in a pediatric population.
abstract: OBJECTIVE
  Total pancreatectomy and islet autotransplant (TP-IAT) is a potential treatment for children with severe refractory chronic pancreatitis. Cultures from the resected pancreas and final islet preparation are frequently positive for microbes. It is unknown whether positive cultures are associated with adverse outcomes in pediatric patients.
  
  
  METHODS
  We reviewed the medical records of children (n = 86) who underwent TP-IAT from May 2006-March 2015 with emphasis on demographics, previous pancreatic interventions, culture results, islet yield, hospital days, posttransplant islet function, and posttransplant infections. We compared outcomes in patients with positive (n = 57) and negative (n = 29) cultures.
  
  
  RESULTS
  Patients with positive cultures had higher rates of previous pancreas surgery (P = 0.007) and endoscopic retrograde cholangiopancreatography (P < 0.0001). Positive cultures were not associated with posttransplant infections (P = 1.00) or prolonged hospital length of stay (P = 0.29). Patients with positive final islet preparation culture showed increased rates of graft failure at 2 years posttransplant (P = 0.041), but not when adjusted for islet mass transplanted (P = 0.39).
  
  
  CONCLUSIONS
  Positive cultures during pediatric TP-IATs do not increase the risk of posttransplant infections or prolong hospital length of stay. Endocrine function depends on islet mass transplanted.
authors.affiliation: Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA. Electronic address: roone083@umn.edu.
authors.forename: Megan G
authors.initials: MG
authors.lastname: Berger
authors.affiliation: Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Kaustav
authors.initials: K
authors.lastname: Majumder
authors.affiliation: Department of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Hodges
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA; Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Sarah Jane
authors.initials: SJ
authors.lastname: Schwarzenberg
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.affiliation: Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.affiliation: Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.affiliation: Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Wilhelm
authors.affiliation: Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA; Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.affiliation: Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
mesh_terms: D000293:Adolescent; D064592:Autografts; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004340:Drug Contamination; D005260:Female; D006084:Graft Rejection; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D010180:Pancreatectomy; D010186:Pancreatic Function Tests; D050500:Pancreatitis, Chronic / Q000378:metabolism / Q000601:surgery; D019999:Pharmaceutical Solutions / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019999:Pharmaceutical Solutions
keywords: Chronic pancreatitis; Infection; Islet autotransplant; Pediatric; Sterility culture; Total pancreatectomy