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Am J Transplant. 2018 Dec 14. doi: 10.1111/ajt.15219. [Epub ahead of print]

Diabetes-free survival after extended distal pancreatectomy and islet auto transplantation for benign or borderline/malignant lesions of the pancreas.

Author information

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
Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
4
Clinical Transplant Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
5
Vita-Salute San Raffaele University, Milan, Italy.

Abstract

Islet autotransplantation is particularly attractive to prevent diabetes after extended pancreatectomy for benign or borderline/malignant pancreas disease. Between 2008 and 2018, 25 patients underwent left extended pancreatectomy (>60%) and islet autotransplantation for neoplasm located in the pancreatic neck or proximal body. Overall, disease-free and diabetes-free survivals were estimated and compared with those observed in 68 non diabetic patients who underwent distal pancreatectomy for pancreatic neoplasms without islet autotransplantation. Median follow-up was 4 years. We observed no deaths and a low morbidity (non-serious procedure-related complications in 2 out of 25 patients). Patient and insulin independent survival at 4 years was 100% and 96%, respectively. Glucose homeostasis remained within non-diabetic range at all times for 19 out of 25 patients (73%). Preoperative glycemic level and insulin resistance were major predictors of diabetes development in these patients. Patients undergoing islet autotransplantation had a longer diabetes-free survival than patients without islet autotransplantation (p=0.04). In conclusion, islet autotransplantation after extended pancreatic resection for neoplasm is a safe and successful procedure for preventing diabetes. This article is protected by copyright. All rights reserved.

PMID:
30549450
DOI:
10.1111/ajt.15219

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