Remote Isolation in Total Pancreatectomy and Auto-Islet Transplantation

Australian Islet Transplant Consortium. Introduction: Total Pancreatectomy and Islet-Auto Transplant (TPIAT) is only available in two locations in Australia at present. TPIAT is currently offered in South Australia for patients with confirmed chronic and hereditary pancreatitis however relies on remote isolation 730km away, causing extended cold ischemic time. This study aims to illustrate patients’ outcomes until 12 months post TPIAT surgery with lengthened ischemic times.Method: This is a retrospective cohort analysis of 10 of 11 patients who underwent TPIAT for Chronic Pancreatitis from 2015 to 2020. Metabolic outcomes, c-peptide, glycated haemoglobin (HbA1c), insulin requirement and analgesia requirement are observed at baseline, 3-, 6- and 12-months post-surgery compared with cold ischemia times, islet equivalent counts and islet equivalents per kilogram of body weight. Results: Of the 11-patient cohort, patients who had bloods at 12 months post, all show detectable c-peptide ranging from 0.05 to 0.89nmol/L. The median HbA1c is at 12 months 6.6%. Insulin Independence was observed in 50% of patients. Nil analgesia requirements were observed in 60% of patients. 1 recipient died 3 days post TPIAT due to cardiac complications, and refusal of blood product transfusions due to religious reasons. The median islet equivalent per kilogram of body weight was 5276 ranged from 1130 to 11665 with a median total ischemic time 11:52hrs from pancreatectomy to transplant.Conclusion: Despite the pancreas needing to be shipped by air for Islet Isolation interstate, South Australia’s TPIAT program has demonstrated to be a successful treatment for chronic pancreatitis improving quality life shown by significant reduction in narcotic dependence, insulin independence and stable glycaemia control. Kidney, Transplant & Diabetes Research Australia. References: 1. Collaborative Islet Transplant Registry