Total pancreatectomy with autologous islet transplantation for malignancy: feasibility and outcome.

Total pancreatectomy leads to pancreatogenic diabetes, the control of which is very difficult, due to the loss of both insulin and glucagon production. A possibility to alleviate diabetes brittleness in this condition is to transplant islets prepared from the resected gland as an autotransplantation. Here is reported a mini-series of pancreatic islet autotransplantation (IATx) in patients with preoperative diagnosis of malignancy in the head of pancreas that required total pancreatectomy to avoid high-risk pancreatic fistula and to prevent brittle surgical diabetes. The results were compared with patients undergone total pancreatectomy alone for malignant disease. From December 2016 to August 2018 seven patients (ranged from 44 to 81 years) underwent total pancreatectomy due to locally advanced head pancreatic cancer followed by IATx. Islets were prepared by enzymatic digestion and density gradient purification in a collaboration between Pisa and Geneve. Intraportal infusion of the isolated islets was performed the day after the surgical operation by ultrasound guide. Data on post-operative morbidity and mortality were analysed and a comparison of glycemic trend within 10th post-operative day was performed. Patient underwent total pancreatectomy and IATx showed a better glycemic control, with stable blood glucose levels than patients underwent total pancreatectomy alone. A lower rate of complications was registered in IATx group and no complication related to transplant procedure was experienced. Three patients (42.9%) reached insulin independence before discharge and C-peptide values between 1.18 and 1.77 ng/mL. The minimum follow-up was 2 months, while the longer 20 months. This early experience shows that autologous islet transplantation after total pancreatectomy allows for insulin-independence and/or improved metabolic control in the majority of patients. The oncologic safety of this procedure remains to be established in a larger series with longer follow-up.