Metabolic Assessment Prior to Total Pancreatectomy and Islet Autotransplant: Utility, Limitations and Potential

Islet autotransplant (IAT) may ameliorate postsurgical diabetes following total pancreatectomy (TP), but outcomes are dependent upon islet mass, which is unknown prior to pancreatectomy. We evaluated whether preoperative metabolic testing could predict islet isolation outcomes and thus improve asses...

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Bibliographic Details
Published in:	American journal of transplantation Vol. 13; no. 10; pp. 2664 - 2671
Main Authors:	Lundberg, R., Beilman, G. J., Dunn, T. B., Pruett, T. L., Chinnakotla, S. C., Radosevich, D. M., Robertson, R. P., Ptacek, P., Balamurugan, A. N., Wilhelm, J. J., Hering, B. J., Sutherland, D. E. R., Moran, A., Bellin, M. D.
Format:	Journal Article
Language:	English
Published:	Hoboken, NJ Wiley 01-10-2013 Elsevier Limited
Subjects:	Adult autoislet Biological and medical sciences Blood Glucose - metabolism C-Peptide - analysis chronic pancreatitis Diabetes Diabetes mellitus Diabetes Mellitus, Type 1 - prevention & control Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen Glucose Tolerance Test Humans Hyperglycemia islet transplant Islets of Langerhans - metabolism Islets of Langerhans Transplantation Liver, biliary tract, pancreas, portal circulation, spleen Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Other diseases. Semiology Pancreas Pancreatectomy pancreatitis Pancreatitis, Chronic - surgery Peptides Postoperative Complications - prevention & control Preoperative Care Prognosis Prospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system total pancreatectomy Transplantation, Autologous Endocrinopathy chronic pancreatitis islet transplant Diabetes mellitus Langerhans islet Pancreatectomy Pancreatitis Homograft Transplantation Metabolism Autotransplantation Chronic Treatment autoislet Surgery Limitation Total Graft Digestive diseases Pharmacokinetics total pancreatectomy Endocrine pancreas Pancreatic disease pancreatitis
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Summary:	Islet autotransplant (IAT) may ameliorate postsurgical diabetes following total pancreatectomy (TP), but outcomes are dependent upon islet mass, which is unknown prior to pancreatectomy. We evaluated whether preoperative metabolic testing could predict islet isolation outcomes and thus improve assessment of TPIAT candidates. We examined the relationship between measures from frequent sample IV glucose tolerance tests (FSIVGTT) and mixed meal tolerance tests (MMTT) and islet mass in 60 adult patients, with multivariate logistic regression modeling to identify predictors of islet mass ≥2500 IEQ/kg. The acute C‐peptide response to glucose (ACRglu) and disposition index from FSIVGTT correlated modestly with the islet equivalents per kilogram body weight (IEQ/kg). Fasting and MMTT glucose levels and HbA1c correlated inversely with IEQ/kg (r values −0.33 to −0.40, p ≤ 0.05). In multivariate logistic regression modeling, normal fasting glucose (<100 mg/dL) and stimulated C‐peptide on MMTT ≥4 ng/mL were associated with greater odds of receiving an islet mass ≥2500 IEQ/kg (OR 0.93 for fasting glucose, CI 0.87–1.0; OR 7.9 for C‐peptide, CI 1.75–35.6). In conclusion, parameters obtained from FSIVGTT correlate modestly with islet isolation outcomes. Stimulated C‐peptide ≥4 ng/mL on MMTT conveyed eight times the odds of receiving ≥2500 IEQ/kg, a threshold associated with reasonable metabolic control postoperatively. In adult patients with chronic pancreatitis undergoing total pancreatectomy and islet autotransplant, the authors show that metabolic testing performed prior to transplant is modestly helpful in predicting which patients are likely to have at least a moderate islet mass isolated for transplant.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1600-6135 1600-6143
DOI:	10.1111/ajt.12392