The impact of bacterial colonization on graft success after total pancreatectomy with autologous islet transplantation: considerations for early definitive surgical intervention

Abstract

Objective The purpose of this study was to determine whether bacterial contamination of islets affects graft success after total pancreatectomy with islet autotransplantation (TPIAT). Background Factors associated with insulin independence after TPIAT are inconclusive. Although bacterial contamination does not preclude transplantation, the impact of bacterial contamination on graft success is unknown. Methods Patients who received TPIAT at the University of Virginia between January 2007 and January 2016 were reviewed. Patient charts were reviewed for bacterial contamination and patients were prospectively contacted to assess rates of insulin-independence. Results There was no significant difference in demographic or perioperative data between patients who achieved insulin-independence and those who did not. However, six of 27 patients analyzed (22.2%) grew bacterial contaminants from culture of the final islet preparations. These patients had significantly lower islet yield and C-peptide at most recent follow-up (p<0.05), and none of these patients achieved insulin-independence. Conclusions Islet transplant solutions are often culture-positive, likely secondary to pre-procurement pancreatic manipulation and introduction of enteric flora. Although autotransplantation of culture-positive islets is safe, it is associated with higher rates of graft failure and poor islet yield. Consideration should be given to identify patients who may develop refractory chronic pancreatitis and offer early operative management to prevent bacterial colonization.

Impact of microbial contamination of the islet product during total pancreatectomy with islet autotransplantation

“…In the present study, the rate of posttransplant infectious complications, excluding islet infusion‐related complications such as bleeding, portal vein thrombosis, high portal pressure, and heavy fatty liver, was not significantly different between the two groups, in agreement with previous reports . The rate of posttransplant infectious complications in all patients was 12.9% (14/108), which is quite a bit lower than that in a previous report .…”

“…In TPIAT, contamination rates have been reported to range from 39% to 82.2% for pancreas preservation medium and from 22.2% to 64.3% for final islet preparations . Recent studies concluded that microbial contamination does not influence posttransplant complications . For example, Jolissaint et al reported that culture‐positive islets were not related to posttransplant complications but were associated with higher rates of graft failure and poor islet yield in TPIAT .…”

“…Recent studies concluded that microbial contamination does not influence posttransplant complications . For example, Jolissaint et al reported that culture‐positive islets were not related to posttransplant complications but were associated with higher rates of graft failure and poor islet yield in TPIAT . Furthermore, Berger et al showed that positive cultures during pediatric TPIAT were not associated with an increase in posttransplant infections .…”

Pancreas preservation fluid microbial contamination is associated with poor islet isolation outcomes - a multi-centre cohort study

“…Consistent with our findings, in an autotransplantation setting, Jolissaint et al . also found that bacterial contaminants in the final islet preparation were associated with lower islet yield and lower C‐peptide/insulin independence rates in six patients. However, such small number of patients does not allow definitive conclusion and the situation could be different in this latter study because contamination is usually present at a higher load in patient with chronic pancreatitis and pancreatic duct dilatation and obstruction.…”

Total Pancreatectomy with Autologous Islet Cell Transplantation—The Current Indications

“…In this study, patients with islets suspected to be positive for cultures ( p = 0.01), and with positive gram stains ( p = 0.02), were associated with worse procedure results [ 71 ]. Jolissaint et al [ 72 ] reported worse results among patients with bacterial contaminants in the final islet preparations. In these patients, a significantly lower islet yield and C-peptide level and no insulin independence following surgery were noted.…”