title: Salvage Islet Auto Transplantation After Relaparatomy.
abstract: To assess feasibility, safety, and metabolic outcome of islet auto transplantation (IAT) in patients undergoing completion pancreatectomy because of sepsis or bleeding after pancreatic surgery.
  
  
  
  From November 2008 to October 2016, approximately 22 patients were candidates to salvage IAT during emergency relaparotomy because of postpancreatectomy sepsis (n = 11) or bleeding (n = 11). Feasibility, efficacy, and safety of salvage IAT were compared with those documented in a cohort of 36 patients who were candidate to simultaneous IAT during nonemergency preemptive completion pancreatectomy through the pancreaticoduodenectomy.
  
  
  
  The percentage of candidates that received the infusion of islets was significantly lower in salvage IAT than simultaneous IAT (59.1% vs 88.9%, P = 0.008), mainly because of a higher rate of inadequate islet preparations. Even if microbial contamination of islet preparation was significantly higher in candidates to salvage IAT than in those to simultaneous IAT (78.9% vs 20%, P < 0.001), there was no evidence of a higher rate of complications related to the procedure. Median follow-up was 5.45 ± 0.52 years. Four (36%) of 11 patients reached insulin independence, 6 patients (56%) had partial graft function, and 1 patient (9%) had primary graft nonfunction. At the last follow-up visit, median fasting C-peptide was 0.43 (0.19-0.93) ng/mL; median insulin requirement was 0.38 (0.04-0.5) U/kg per day, and median HbA1c was 6.6% (5.9%-8.1%). Overall mortality, in-hospital mortality, metabolic outcome, graft survival, and insulin-free survival after salvage IAT were not different from those documented after simultaneous IAT.
  
  
  
  Our data demonstrate the feasibility, efficacy, and safety of salvage IAT after relaparotomy.
authors.affiliation: 1 Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy. 2 Diabetes Research Institute; IRCCS San Raffaele Scientific Institute, Milan, Italy. 3 Clinical Transplant Unit, Division of Immunology, Transplantation and Infectious Diseases; IRCCS San Raffaele Scientific Institute, Milan, Italy. 4 Humanitas Clinical and Research Center, Pancreatic Surgery, Rozzano, Italy. 5 Humanitas Clinical and Research Center, Diabetology, Rozzano, Italy. 6 Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 7 Vita-Salute San Raffaele University, Milan, Italy. 8 Humanitas University, Department of Biomedical Sciences, Rozzano, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Rita
authors.initials: R
authors.lastname: Nano
authors.forename: Paola
authors.initials: P
authors.lastname: Maffi
authors.forename: Alessia
authors.initials: A
authors.lastname: Mercalli
authors.forename: Raffaelli
authors.initials: R
authors.lastname: Melzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Aleotti
authors.forename: Francesca
authors.initials: F
authors.lastname: Gavazzi
authors.forename: Cesare
authors.initials: C
authors.lastname: Berra
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.forename: Paola
authors.initials: P
authors.lastname: Magistretti
authors.forename: Marina
authors.initials: M
authors.lastname: Scavini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capretti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
authors.forename: Antonio
authors.initials: A
authors.lastname: Secchi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Piemonti
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D014182:Transplantation, Autologous