Clinical Research Fellow
Department of Hepatobiliary and Pancreatic Surgery
University Hospitals of Leicester
Assessement of long-term graft function following total pancreatectomy and autologous islet transplantation
Cristina Pollard1, Rohan Kumar1, Wen Y Chung1, Jill Cooke1, Giuseppe Garcea1, Ashley R Dennison1.
1Hepato-Biliary & Pancreas Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Introduction: Islet auto-transplantation (IAT) following total pancreatectomy (TP) is now a recognised albeit highly specialised procedure carried out in a small number of centres worldwide. TPIAT has the potential to prevent the onset of diabetes in a number of patients, and a significant cohort, retain insulin secretion and the benefits of endogenous C-peptide production. C-peptide is released by β islets in equimolar concentrations to insulin and has been shown to reduce diabetic renal nephropathy, improve sensory nerve function/neuropathy and preserve microvasculature circulation.
Methods: A prospective data base of 60 TP/IAT patients from September 1995 to May 2015 was analysed. Sixteen patients were deceased. Twenty-nine patients were available for follow-up at ten years or greater (> = 120 months) following IAT. Long term islet graft function was assessed in 13 of these 29 patients using C-peptide as a marker of endogenous insulin production. C-peptide levels at baseline (following an overnight fast) and at 120 minutes (following a standard 75gr oral glucose tolerance test) were assessed and interrogated using non-parametric data analysis.
Results: Median follow up from operation was 126 months [range 120 – 240 months].Median HbA1c was 8.0% [5.3% - 17.0%] (normal < 6.5%). Median fasting glucose at baseline was 8.5mM [4.1mM – 32.7mM]. Median baseline C-peptide levels following overnight fasting was 1.48 ng.mL-1 [Range 0.87 ng.mL-1 – 6.13 ng.mL-1]. Median C-peptide levels at 120 minutes, following oral glucose tolerance test, was 2.51 ng.mL-1 [Range 1.08 ng.mL-1 – 19.6 ng.mL-1]. Furthermore stimulated C-peptide levels were higher than baseline levels and reached statistical significance p value < 0.05, p = 0.007).
Conclusion: All thirteen patients underwent TP with IAT at median of 10.5 years ago [range 10 to 20 years]. All patients demonstrated the presence of endogenous insulin production. Stimulated C-peptide levels were demonstrated to be higher than baseline unstimulated levels supporting long-term graft survival and preservation of function.
11:00 - 12:30
|Islet auto transplantation: state-of-the-art||Assessement of long-term graft function following total pancreatectomy and autologous islet transplantation||Plenary Room 1|
17:30 - 18:30
|Joint Poster Session||Deficiency of mannose-binding lectin–dependent lectin pathway in the pancreatic islet auto-transplantation||Main Foyer 1 & 2|