Professor and Chairman
VCU Medical Centre
Do Surgical Complications Adversely Affect Total Pancreatectomy with Islet Autotransplantation Outcome?
Rauf Shahbazov2, Omar S Khan2, Giovanna Saracino1, Ali Dabous1, Gumpei Yoshimatsu2, Morihito Takita2, Mazhar A Kanak3, Michael C Lawrence2, Peter T Kim1, Bashoo Naziruddin1, Marlon F Levy1.
1Transplant Services, Baylor Simmons Transplant Institute, Dallas, TX, United States; 2Islet Cell Laboratory, Baylor Research Institute, Dallas, TX, United States; 3Institute of Biomedical Studies, Baylor University, Waco, TX, United States
Introduction: Total pancreatectomy with islet autotransplantation (TPIAT) is a promising treatment option for chronic pancreatitis (CP) patients who have intractable pain. However, this procedure has many challenges due to high rate of morbidity. The objective of this analysis is to determine the effects of postoperative complications in TPIAT patients and their impact on islet cell function.
Methods: Baylor Simmons Transplant Institute patient database was queried to identify all patients undergoing TPIAT from 2006 to 2015. Moreover, the database was queried for demographics, preoperative risk factors, intraoperative variables, and 30- and 90-days postoperative morbidity and mortality. Eighty-three patients with TPIAT and at least 1 year follow-up were included. All patients previously diagnosed with CP were evaluated by a multidisciplinary team. The indications for surgery were intractable pain despite previous medical and surgical intervention. Total pancreatectomy was performed in all patients and isolated islets were infused into the portal vein. The average daily insulin requirement, HbA1c and C-peptide levels were measured before surgery, on hospital discharge, and at each subsequent postoperative patient visit. Narcotic requirements were reported as morphine-equivalent quantity per day (MEQ/d) calculated from narcotic conversion software. Adverse events (AE) were recorded and graded using the Common Terminology Criteria for AE in TPIAT. Overall postoperative complication detected and graded according to Clavien-Dindo classification. The Wilcoxon two-sample test, Kaplan-Meier and linear mixed regression models were used to compare groups.
Results: There was no mortality in this patient group. The postoperative complications occurred in 38 patients (45.7%). Patients with postoperative complications where readmitted significantly more often within 30-day (39.5% vs. 13.3%, p-value=0.0104) and 90-day post-transplant (76.3% vs. 35.6%, p-value<0.0003), had a significantly longer hospital stay (median 12 vs. 11 days, p-value=0.004) and ICU stay (median 1 vs. 2 days, p-value=0.001). Insulin dependence and graft function were not affected significantly by complications. Postoperative complications showed a tendency to increase narcotic requirements in the postoperative period, although this result is not statistically significant.
Conclusion: Postoperative complications after TPIAT procedure are associated with hospital and ICU stay, and with readmissions. However, such complications do not have an adverse effect on islet graft function.
11:00 - 12:30
|Islet auto transplantation: state-of-the-art||Effects of Pylorus Preservation Procedure on Patient Outcome in Total Pancreatectomy with Islet Autotransplantation||Plenary Room 1|
11:00 - 12:30
|Islet auto transplantation: state-of-the-art||Do Surgical Complications Adversely Affect Total Pancreatectomy with Islet Autotransplantation Outcome?||Plenary Room 1|