Single-centre experience of extending indications for percutaneous intraportal islet autotransplantation (PIPIAT) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome

Portal Vein Thrombosis May Be More Strongly Associated With Islet Infusion Than Extreme Thrombocytosis After Total Pancreatectomy With Islet Autotransplantation

“…PVT incidence after TPIAT at other institutions has been published in a few small series; contemporary incidence rates range from 0.9% to 4.2%. 14,40,41 This study’s PVT rate was slightly higher than those previous publications but is similar to published data from our group in an overlapping, but smaller and highly selected, TPIAT cohort from our center. 13 PVT rates in large non-TPIAT cohorts (>100 participants) after open splenectomy vary widely, ranging from 0.39% to 4.8%.…”

Cell Therapy for Type 1 Diabetes: From Islet Transplantation to Stem Cells

“…Additional indications for autotransplant other than chronic pancreatitis are still controversial [27] and have been limited to the procedure performed only in small case series [28,29] of benign enucleable tumors or pancreatic trauma. Recently, broader selection criteria for autotransplant were suggested [30][31][32][33], exploring the possibility of extending autotransplant to patients with known malignancy, either having completion pancreatectomy as treatment for severe pancreatic fistulae or extensive distal pancreatectomy for neoplasms of the pancreatic neck or pancreatoduodenectomy because of high risk of pancreatic fistula.…”

Interventional Radiological Management and Prevention of Complications after Pancreatic Surgery: Drainage, Embolization and Islet Auto-Transplantation

“…Islet transplantation demonstrated significant beneficial effects in the prevention/stabilization of diabetic complications [ 103 , 104 , 105 , 106 , 107 ]. Auto-transplantation was more recently introduced not to cure type 1 diabetes but to prevent another type of diabetes known as “pancreatogenic diabetes” [ 19 , 20 , 21 , 22 , 23 ]. The origin of pancreatogenic diabetes is caused from an extreme disruption of glucose homeostasis after extensive pancreatic resection such as subtotal/total pancreatectomy for tumors or chronic pancreatitis [ 108 , 109 , 110 , 111 , 112 ].…”

“…Technically, allo- and auto-transplantation are similar procedures which are performed by interventional radiologists in the same way. Anyway, auto-transplantation is performed 12–48 h after pancreatic surgery: this peculiar situation may cause hemodynamic instability and a suboptimal ultrasound visibility due to residual abdominal air, which may hinder the procedure [ 21 ].…”

“…Several IR procedures, such as the percutaneous drainage of fluid collections due to pancreatic fistulas, percutaneous transhepatic biliary drainage (PTBD) in case of bile leakage and arterial transcatheter embolization (or covered stenting) in case of post-operative hemorrhage, constitute minimally invasive procedures with a consequent reduction in the hospital stay and a considerable decrease in morbidity and mortality [ 17 , 18 ]. In selected and experienced centers, IR is also involved in the prevention of pancreatogenic diabetes after extensive pancreatic resections through percutaneous intraportal islet auto-transplantation [ 19 , 20 , 21 , 22 , 23 ]. This pictorial review is focused on interventional radiological management and the prevention of complications after pancreatic surgery, providing an update of the current scientific literature.…”