Document Detail


Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach.
MedLine Citation:
PMID:  21689235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In selected patients with chronic pancreatitis, extensive pancreatectomy can be effective for the treatment of intractable pain. The resultant morbid diabetes can be ameliorated with islet autotransplantation (IAT). Conventionally, islet infusion occurs intraoperatively after islet processing. A percutaneous transhepatic route in the immediate postoperative period is an alternative approach.
METHODS: A prospectively collected database of patients undergoing pancreatectomy with percutaneous IAT (P-IAT) was reviewed. Hospital billing data were obtained and median charges determined and compared with estimated charges for an intraoperative infusion method of IAT (I-IAT).
RESULTS: Thirty-six patients (28 women; median age 48 years) underwent pancreatectomy with P-IAT. Median operative time was 232 min (range: 98-395 min) and median estimated blood loss was 500 cc (range: 75-3000 cc). Median time from pancreatic resection to islet transplantation was 269 min (range: 145-361 min). A median of 208 248 IEq (2298 IEq/kg) were harvested. Median peak portal venous pressure during islet infusion was 13 mmHg (range: 5-37 mmHg). Postoperative complications occurred in 15 patients (42%) and included hepatic artery pseudoaneurysm and portal vein thrombosis; the latter occurred in two patients with portal pressures during infusion > 30 mmHg. At a median follow-up of 10.7 months, eight patients (22%) were insulin-free. Median pertinent charges for P-IAT were US$36,318 and estimated median charges for I-IAT were US$56,440. Surgeon time freed by P-IAT facilitated an additional 66 procedures, charges for which amounted to US$463,375.
CONCLUSIONS: Percutaneous transhepatic IAT is feasible and safe. Islet infusion in the immediate postoperative period is cost-effective. Further follow-up is needed to assess longterm results.
Authors:
Katherine A Morgan; Michael Nishimura; Renan Uflacker; David B Adams
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  HPB : the official journal of the International Hepato Pancreato Biliary Association     Volume:  13     ISSN:  1477-2574     ISO Abbreviation:  HPB (Oxford)     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-21     Completed Date:  2012-01-27     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100900921     Medline TA:  HPB (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  511-6     Citation Subset:  IM    
Copyright Information:
© 2011 International Hepato-Pancreato-Biliary Association.
Affiliation:
Departments of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. morganka@musc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Diabetes Mellitus / etiology,  therapy*
Feasibility Studies
Female
Humans
Islets of Langerhans Transplantation / methods*
Male
Middle Aged
Pancreatectomy*
Pancreatitis, Chronic / surgery*
Transplantation, Autologous
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
HPB (Oxford). 2011 Sep;13(9):596   [PMID:  21843258 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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