Intraportal Islet Autotransplantation Independently Improves Quality of Life After Total Pancreatectomy in Patients With Chronic Refractory Pancreatitis

Abstract

Objective: To determine if islet autotransplantation (IAT) independently improves the quality of life (QoL) in patients after total pancreatectomy and islet autotransplantation (TP-IAT). Background: TP-IAT is increasingly being used for intractable chronic pancreatitis. However, the impact of IAT on long-term islet function and QoL is unclear. Methods: TP-IAT patients at our center >1 year after TP-IAT with ≥1 Short Form-36 QoL measure were included. Patients were classified as insulin-independent or insulin-dependent, and as having islet graft function or failure by C-peptide. The associations of insulin use and islet graft function with QoL measures were analyzed by using a linear mixed model, accounting for time since transplant and within-person correlation. Results: Among 817 islet autograft recipients, 564 patients [median (interquartile range) age: 34 (20, 45) years, 71% female] and 2161 total QoL surveys were included. QoL data were available for >5 years after TP-IAT for 42.7% and for >10 years for 17.3%. Insulin-independent patients exhibited higher QoL in 7 of 8 subscale domains and for Physical Component Summary and Mental Component Summary scores (P<0.05 for all). Physical Component Summary was 2.91 (SE=0.57) higher in insulin-independent patients (P<0.001). No differences in QoL were observed between those with and without graft function, but islet graft failure was rare (15% of patients). However, glycosylated hemoglobin was much higher with islet graft failure. Conclusions: QoL is significantly improved when insulin independence is present, and glycosylated hemoglobin is lower with a functioning islet graft. These data support offering IAT, rather than just performing total pancreatectomy and treating with exogenous insulin.

A static glucose-stimulated insulin secretion (sGSIS) assay that is significantly predictive of time to diabetes reversal in the human islet bioassay

“…Transplantation of autologous human islets is considered a therapeutic option for the palliative treatment of chronic pain in people undergoing total pancreatectomy 44 45. Transplantation of human islets obtained from allogeneic, cadaveric pancreata has shown remarkable impact in restoring metabolic control in people with brittle type 1 diabetes worldwide 46.…”

Current status of total pancreatectomy with islet autotransplantation for chronic and recurrent acute pancreatitis

“…32 Furthermore, the health-related QoL (HRQoL) has improved after TPAIT even in patients who are insulin-dependent. 65 Therefore, TPAIT is more effective than TP alone for CP.…”

“…Similar to islet allotransplantation, autologous islets are not completely functional immediately after transplantation, and intraoperative glycemic control with continuous intravenous insulin infusion is required against hyperglycemic toxicity. 49,65 Because the patient's own cells are transplanted, unlike the procedure used in allo-islet transplantation, no immunosuppressive drugs are administered. The subcutaneous injections of insulin are then transitioned to maintain euglycemia within the first 3 months after TPAIT.…”

“…Moreover, in patients at the Medical University of South Carolina, the insulin withdrawal rate after TPAIT was 23% at 5 years 32 . Furthermore, the health‐related QoL (HRQoL) has improved after TPAIT even in patients who are insulin‐dependent 65 . Therefore, TPAIT is more effective than TP alone for CP.…”

Peri-Transplant Inflammation and Long-Term Diabetes Outcomes Were Not Impacted by Either Etanercept or Alpha-1-Antitrypsin Treatment in Islet Autotransplant Recipients

“…Long-term insulin independence is an important goal in TPIAT as it reduces the burden of diabetes management and improves quality of life [ 4 ]. Many patients, however, never reach insulin independence.…”