Salvage Islet Auto Transplantation After Relaparatomy

BACKGROUND: To assess feasibility, safety and metabolic outcome of islet auto transplantation (IAT) in patients undergoing completion pancreatectomy because of sepsis or bleeding following pancreatic surgery. METHODS: From November 2008 to October 2016, 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 to those documented in a cohort of 36 patients who were candidate to simultaneous IAT during nonemergency preemptive completion pancreatectomy through the pancreaticoduodenectomy. RESULTS: 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 due to 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 out of 11 patients (36%) reached insulin independence; 6 patients (56%) had partial graft function, 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 0.38 (0.04-0.5) U/kg/day and median HbA1c 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. CONCLUSIONS: Our data demonstrate the feasibility, efficacy, and safety of salvage IAT after relaparotomy.