Endocrine Abstracts (2015) 37 GP14.08 | DOI: 10.1530/endoabs.37.GP.14.08

Factors associated with islet yield and insulin independence after total pancreatectomy and islet cell autotransplantation in patients with chronic pancreatitis utilising off-site islet isolation: Cleveland Clinic experience

Philip C Johnston1, Yu Lin1, Matthew Walsh1, Tyler Stevens1, Rita Bottino2, Massimo Trucco2, James Bena1 & Betul Hatipoglu1

1Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA; 2Division of Immunogenetics, Department of Paediatrics, University of Pittsburgh, Pittsburg, Pennsylvania, USA.

Context: Total pancreatectomy (TP) with islet cell autotransplantation (IAT) can reduce or prevent diabetes by preserving β-cell function, and is normally performed with on-site isolation laboratory facilities.

Objective: We examined factors associated with islet yield and metabolic outcomes in patients with chronic pancreatitis undergoing TP-IAT. We report our experience of TP-IAT with an off-site islet isolation laboratory.

Patients and methods: Data (August 2008–February 2014) were obtained from a TP-IAT database which included information from medical records, clinic visits, questionnaires and follow-up telephone calls. Each patient was assessed with pre- and post-operative 5-h mixed meal tolerance tests for metabolic measurements and with serial HbA1c determinations.

Results: Thirty-six patients with a mean age of 38 years (range 16–72 years) underwent TP-IAT for different aetiologies. At a median follow-up time of 28 months (range 3–66), 12 patients were insulin independent and 24 patients were on at least one insulin injection a day. Post-operatively, C-peptide levels ≥0.3 ng/ml were present in 23/33 (70%) of the patients, with a median fasting C-peptide value of 0.8 ng/ml (range <0.2–1.5 ng/ml). Those who were insulin independent were more likely to be female (P=0.012), have normal morphology on pre-operative pancreatic imaging (P=0.011), and have significantly higher median islet yield (6845 IEQ/kg, n=12 vs 3333 IEQ/kg, n=24; P<0.001).

Conclusions: Islet cell autotransplantation after total pancreatectomy performed in our facility with an off-site islet isolation laboratory shows islet yield and rates of insulin independence that are comparable to other large centres with on-site laboratories.