Long-Term Glycemic Control in Adult Patients Undergoing Remote vs. Local Total Pancreatectomy With Islet Autotransplantation.
Total pancreatectomy with islet autotransplantation (TPIAT) is increasingly performed with remote islet cell processing and preparation, i.e., with islet cell isolation performed remotely from the primary surgical site at an appropriately equipped islet isolation facility. We aimed to determine whether TPIAT using remote islet isolation results in comparable long-term glycemic outcomes compared with TPIAT performed with standard local isolation.



We performed a retrospective cohort study of adult patients who underwent TPIAT at three tertiary care centers from 2010 to 2013. Two centers performed remote isolation and one performed local isolation. Explanted pancreata in the remote cohort were transported ∼130 miles to and from islet isolation facilities. The primary outcome was insulin independence 1 year following transplant.



Baseline characteristics were similar between groups except the remote cohort had higher preoperative hemoglobin A1c (HbA1c; 5.43 vs. 5.25, P=0.02) and there were more females in the local cohort (58% vs. 76%, P=0.049). At 1 year, 27% of remote and 32% of local patients were insulin independent (P=0.48). Remote patients experienced a greater drop in fasting c-peptide (-1.66 vs. -0.64, P=0.006) and a greater rise in HbA1c (1.65 vs. 0.99, P=0.014) at 1-year follow-up. A preoperative c-peptide >2.7 (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.6-14.3) and >3,000 islet equivalents/kg (OR 11.0, 95% CI 3.2-37.3) were associated with one-year insulin independence in the local group.



At 1 year after TPIAT, patients undergoing remote surgery have equivalent rates of long-term insulin independence compared with patients undergoing TPIAT locally, but metabolic control is superior with local isolation.
Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Samuel J
SJ
Kesseli
Section of Endocrinology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Matthew
M
Wagar
Section of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Min K
MK
Jung
Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Kerrington D
KD
Smith
Department of Endocrinology, Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Yu Kuei
YK
Lin
Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
R Matthew
RM
Walsh
Section of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Betul
B
Hatipoglu
Section of Gastroenterology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Martin L
ML
Freeman
Deparment of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Timothy L
TL
Pruett
Deparment of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Gregory J
GJ
Beilman
Deparment of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
David E R
DE
Sutherland
Deparment of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Ty B
TB
Dunn
Section of Transplant Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
David A
DA
Axelrod
Section of Endocrinology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Sushela S
SS
Chaidarun
Section of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Tyler K
TK
Stevens
Section of Endocrinology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Melena
M
Bellin
Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Timothy B
TB
Gardner
D000208:Acute Disease; D000328:Adult; D002096:C-Peptide / Q000378:metabolism; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006268:Health Facilities; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D010180:Pancreatectomy / Q000379:methods*; D010195:Pancreatitis / Q000378:metabolism / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000378:metabolism / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000379:methods*; D016896:Treatment Outcome
D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human