Tristan J Bampton1,2, D Jane Holmes-Walker3,4, Chris J Drogemuller2, Toni Radford2, Patricia Anderson4, C Etherton2, C H Russell2, S Khurana5, David J Torpy2, J J Couper5, R L T Couper5, Pamela Macintyre2, E L Neo6, Paul Benitez-Aguirre7, G Thomas7,8, T Loudovaris9, H E Thomas9, Lyle J Palmer10, Denghao Wu1, Natasha M Rogers4,11, L Williams4, W J Hawthorne4,11,12, P J O'Connell4,11, Tom W Kay9, Henry Pleass4,7,11,12, John W Chen2,5, P Toby Coates1,2. 1. Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia. 2. The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia. 3. Department of Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia. 4. Westmead Institute for Medical Research, Sydney, New South Wales, Australia. 5. Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia. 6. Flinders Medical Centre, Adelaide, South Australia, Australia. 7. Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. 8. Westmead Children's Hospital, Sydney, New South Wales, Australia. 9. Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia. 10. School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia. 11. Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia. 12. Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia. METHODS: Individuals selected for TP-IAT surgery according to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post-transplantation HbA1c, C-peptide, total daily insulin and analgesic requirement. RESULTS: Sixteen individuals underwent TP-IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290-7300). The median C-peptide 1 month post-TP-IAT was 384 (IQR 210-579) pmol/L and at median 29.5 (IQR 14.5-46.5) months from transplant was 395 (IQR 139-862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement. CONCLUSION: The TP-IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.
BACKGROUND: This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia. METHODS: Individuals selected for TP-IAT surgery according to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post-transplantation HbA1c, C-peptide, total daily insulin and analgesic requirement. RESULTS: Sixteen individuals underwent TP-IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290-7300). The median C-peptide 1 month post-TP-IAT was 384 (IQR 210-579) pmol/L and at median 29.5 (IQR 14.5-46.5) months from transplant was 395 (IQR 139-862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement. CONCLUSION: The TP-IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.
Authors: Denghao Wu; Tristan J Bampton; Hamish S Scott; Alex Brown; Karin Kassahn; Christopher Drogemuller; Sunita Mc De Sousa; David Moore; Thuong Ha; John Wc Chen; Sanjeev Khurana; David J Torpy; Toni Radford; Richard Couper; Lyle Palmer; P Toby Coates Journal: Med J Aust Date: 2022-05-16 Impact factor: 12.776