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Total pancreatectomy with islet autotransplantation in diabetic and pre-diabetic patients with intractable chronic pancreatitis

引用

Journal of Pancreatology 2020年第2期3卷 86-92页

作者： Bachul Piotr J. Grybowski Damian J. Anteby Roi Basto Lindsay Perea Laurencia Golab Karolina Wang Ling-Jia Tibudan Martin Gutierrez Angelica P. Komorniczak Michal nagpal sajan Lucander Aaron Fung John Matthews Jeffrey B. Witkowski Piotr Department of Surgery University of ChicagoChicagoILUSA Faculty of Medicine Tel Aviv UniversityTel AvivIsrael Department of Nephrology Transplantology and Internal MedicineMedical University of GdańskGdańskPoland Department of Medicine University of ChicagoChicagoILUSA

Total pancreatectomy with islet autotransplantation(TPIAT)is an effective treatment option for non-diabetic patients with intractable chronic *** outcome and potential benefits for pre-diabetic and diabetic patients are less well ***-four patients underwent TPIAT were retrospectively divided into 3 groups according to pre-operative glycemic control:diabetes mellitus(DM)(n=5,15%),pre-DM(n=11,32%)and non-DM(n=18,54%).Pre-operative fasting c-peptide was detectable and similar in all 3 *** yield in the DM group was comparable to pre-DM and non-DM groups(median islet equivalents[IEQ]was 191,800,111,800,and 232,000 IEQ,respectively).Patients received islet mass of over the target level of 2000 IEQ/kg in pre-DM and DM at lower but clinically meaningful rates compared to the non-DM group:45%(5/11)and 60%(3/5)for a combined 50%(8/16)rate,respectively,compared to 83%(15/18)for the non-DM *** 1 year,fasting c-peptide and HbA1c did not differ between DM and pre-DM groups but c-peptide was significantly higher in *** transplantation failed(negative c-peptide)only in 1 ***,all patients experienced pancreatic pain with daily opioid dependence in 60%to 70%.Pancreatic-type pain gradually subsided completely in all groups with no differences in other painful somatic *** patients with measurable pre-operative c-peptide can achieve similar benefit from TPIAT,with comparable outcomes to pre-diabetic and non-diabetic patients including pain relief and the metabolic benefit of transplanted *** surprisingly,endocrine outcomes for diabetic and prediabetics patients are substantially worse than in those with normal pre-operative glucose control.

关键词： Autotransplantation Islets Outcomes Pancreatectomy Pre-diabetes

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