Pancreatic islet autotransplantation a potential treatment for malignant disease

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1. Patients undergoing pancreatectomy for malignancy may benefit from islet autotransplantation (IAT) used to prevent brittle diabetes. 

2. Post-pancreatecmy patients with malignant disease who underwent IAT had similar disease-free and overall survival to similar patients who did not receive an autotransplant. 

Evidence Rating Level: 2 (Good)           

Study Rundown: Pancreatic islet autotransplantation (IAT) can be conducted after pancreatectomy to prevent brittle diabetes, a difficult condition that has significant effects on quality of life. This procedure has not been used in patients with pancreatic or periampullary carcinoma due to the possibility of re-infusing malignant cells and causing cancer recurrence. This study included 17 patients with malignant and 14 patients with benign neoplasms. After a year and a half of follow-up, only two patients developed recurrence and both overall and disease-free survival was comparable to post-pancreatectomy cancer patients without subsequent IAT treated at the same center. This is the first systematic study of IAT that included patients undergoing pancreatectomy for malignant tumors. Though authors make a case for extending islet autotransplanation to this population, this study is notably small, lacks appropriate controls and could benefit from longer follow-up.

Click to read the study in Annals of Surgery

Click to read an accompanying editorial in Annals of Surgery

Relevant Reading: Five-Year Follow-Up After Clinical Islet Transplantation

In-Depth [prospective cohort study]: This study followed 41 patients eligible for pancreatic islet autotransplantation at a medical center in Milan, Italy. Along with commonly accepted indications for islet transplant such as painful chronic pancreatitis, patients with benign and malignant neoplasms were also considered eligible: 31 of the study participants had pancreatic cancer, periumpullary carcinoma or neoplasms with no or low malignant potential. Additionally, this study included patients with post-pancreaticojejunostomy leakage, commonly excluded for concern of possible infection. After pancreatectomy, 34 patients received either percutaneous 48-hour long islet infusion via peri-hepatic cannulation, intraoperative perfusion directly into the portal vein or bone marrow infusion. Postoperatively, intense 5-day glucose monitoring was followed by serial Dopplers to check for portal vein patency and outpatient visits four times during the first year and annually thereafter. In patients with cancer, serial CT and blood tests were administered every 3-6 months to check for recurrence. Markers of pancreatic function such as fasting C peptide, HbA1c and glucose testing were used as a measure of beta-cell activity. The patients were followed for a median of 546 days. Eight patients had procedure-related complications such as DVT, bleeding and one instance of sepsis. The majority of patients (93%) were either insulin-independent or reached partial graft function. Compared to patients who underwent pancreatectomy without IAT during the same period, the seventeen study participants with malignancy indications had similar duration of disease-free and overall survival. Two out of seventeen developed new metastases post-IAT, however neither had recurrence at the site of transplantation.

By Asya Ofshteyn and Allen Ho 

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