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Total pancreatectomy islet transplantation

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https://www.readbyqxmd.com/read/27870552/glycemic-predictors-of-insulin-independence-after-total-pancreatectomy-with-islet-auto-transplantation
#1
Michael Quartuccio, Erica Hall, Vikesh Singh, Martin A Makary, Kenzo Hirose, Niraj Desai, Christi Walsh, Daniel Warren, Zhaoli Sun, Ellen Stein, Rita R Kalyani
CONTEXT: Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in a subset of patients. Predictors of insulin independence are needed for appropriate patient selection and counseling. OBJECTIVE: To explore glycemic predictors of insulin independence after TPIAT. DESIGN: A prospective cohort of patients undergoing TPIAT from 2011-2016...
November 21, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27760705/clinical-effectiveness-of-a-pylorus-preserving-procedure-on-total-pancreatectomy-with-islet-autotransplantation
#2
Rauf Shahbazov, Gumpei Yoshimatsu, Waqas Z Haque, Omar S Khan, Giovanna Saracino, Michael C Lawrence, Peter T Kim, Nicholas Onaca, Bashoo Naziruddin, Marlon F Levy
BACKGROUND: The impact of pylorus preserving procedures (PP) on total pancreatectomy with islet autotransplantation (TPIAT) has not been examined. This study aimed to investigate the clinical impact of the PP on TPIAT. METHODS: The Baylor Simmons Transplant Institute database was queried to identify seventy-three patients who underwent TPIAT from 2006 to 2014. All patients were investigated in postoperative complications, long-term nutritional status, and graft function...
October 8, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27643615/unmethylated-insulin-dna-is-elevated-after-total-pancreatectomy-with-islet-autotransplant-assessment-of-a-novel-beta-cell-marker
#3
Melena D Bellin, Pamela Clark, Sahar Usmani-Brown, Ty B Dunn, Gregory J Beilman, Srinath Chinnakotla, Timothy L Pruett, Peggy Ptacek, Bernhard J Hering, Zuoheng Wang, Thomas Gilmore, Joshua Wilhelm, James S Hodges, Antoinette Moran, Kevan C Herold
Beta cell death may occur both after islet isolation and during infusion back into recipients undergoing total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis. We measured the novel beta cell death marker unmethylated insulin (INS) DNA in TPIAT recipients before and immediately after islet infusion (n=21), and again 90 days post-TPIAT concurrent with metabolic functional assessments (n=25). As expected, INS DNA decreased after pancreatectomy (p=0.0002). Following islet infusion, all TPIAT recipients had an elevated unmethylated INS DNA ratio in the first hours...
September 19, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27623240/the-impact-of-bacterial-colonization-on-graft-success-after-total-pancreatectomy-with-autologous-islet-transplantation-considerations-for-early-definitive-surgical-intervention
#4
Joshua S Jolissaint, Linda W Langman, Claire L DeBolt, Jacob A Tatum, Allison N Martin, Andrew Y Wang, Daniel S Strand, Victor M Zaydfudim, Reid B Adams, Kenneth L Brayman
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...
September 13, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27610653/spontaneous-hypoglycemia-after-islet-transplantation-the-case-for-using-non-hepatic-sites
#5
R Paul Robertson
This Perspective provides a brief history of intrahepatic alloislet and autoislet transplantation in humans and an update of the recent success rates. It also examines the important role that hypoglycemia plays in clinical outcomes. On the one hand, recurrent serious hypoglycemic episodes related to insulin therapy are a major criterion for alloislet transplantation. On the other hand, spontaneous clinical hypoglycemia, perhaps related to the accompanying Roux-en-Y procedure for total pancreatectomy, is a complication of autoislet transplantation...
October 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27465328/gastric-submucosa-is-inferior-to-the-liver-as-transplant-site-for-autologous-islet-transplantation-in-pancreatectomized-diabetic-beagles
#6
Zhu-Zeng Yin, Shu-Sen Wang, Qiang Li, Ying Huang, Li Chen, Gang Chen, Rong Liu, Xi-Mo Wang
Intraportal transplantation of islets is no longer considered to be an ideal procedure and finding the extrahepatic alternative site is becoming a subject of high priority. Herein, in this study, we would introduce our initial outcomes of using gastric submucosa (GS) and liver as sites of islet autotransplantation in pancreatectomized diabetic Beagles. Total pancreatectomy was performed in Beagles and then their own islets extracted from the excised pancreas were transplanted into GS (GS group, n=8) or intrahepatic via portal vein (PV group, n=5)...
August 2016: Journal of Huazhong University of Science and Technology. Medical Sciences
https://www.readbyqxmd.com/read/27429015/mir-375-and-mir-200c-as-predictive-biomarkers-of-islet-isolation-and-transplantation-in-total-pancreatectomy-with-islet-autotransplantation
#7
Gumpei Yoshimatsu, Morihito Takita, Mazhar A Kanak, Waqas Z Haque, Charles Chang, Prathab Balaji Saravanan, Michael C Lawrence, Marlon F Levy, Bashoo Naziruddin
BACKGROUND: Total pancreatectomy with islet autotransplantation (TPIAT) is a promising treatment for refractory chronic pancreatitis. Predictable biomarkers for the endocrine function after transplantation would be helpful in selecting patients for TPIAT. This study aims to identify novel biomarkers for predicting the outcome of islet isolation and transplantation in TPIAT patients. METHODS: This paper studied microRNA of 31 TPIAT patients and 11 deceased donors from plasma samples before TPIAT...
September 2016: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/27376692/tolerance-of-vascularized-islet-kidney-transplants-in-rhesus-monkeys
#8
V Pathiraja, V Villani, M Tasaki, A J Matar, R Duran-Struuck, R Yamada, S G Moran, E S Clayman, J Hanekamp, A Shimizu, D H Sachs, C A Huang, K Yamada
We previously reported that transplantation (Tx) of prevascularized donor islets as composite islet-kidneys (IK) reversed diabetic hyperglycemia in both miniature swine and baboons. In order to enhance this strategy's potential clinical applicability, we have now combined this approach with hematopoietic stem cell (HSC) Tx in an attempt to induce tolerance in nonhuman primates. IKs were prepared by isolating islets from 70% partial pancreatectomies and injecting them beneath the autologous renal capsule of five rhesus monkey donors at least 3 months before allogeneic IK Tx...
July 4, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27358790/islet-autotransplantation-in-a-patient-with-hypercoagulable-disorder
#9
Chirag S Desai, Khalid M Khan, Wanxing Cui
Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cancer. Portal vein thrombosis is the most feared complication of the surgery and chances are increased if the patient has a hypercoagulable disorder. We present a challenging case of islet auto transplantation from our institution. A 29-year-old woman with plasminogen activator inhibitor-4G/4G variant and a clinical history of venous thrombosis was successfully managed with a precise peri- and post-operative anticoagulation protocol...
June 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/27345954/autotransplantation-of-pancreatic-islets-a-single-center-first-experience
#10
Paolo Magistri, Sara Andreani, Domenico Lo Conte, Giovanni Carlo Ferrari, Antonello Forgione, Raffaele Pugliese
INTRODUCTION: Islets auto-transplantation (IAT) is a well-known procedure that may improve glycemic control after total or completion pancreatectomy compared to insulin therapy alone. CASE REPORT: We herein report our experience in IAT with the case of a sixty years old woman underwent completion pancreatectomy for recurrent pancreatitis. She received IAT by percutaneous trans-hepatic intra-portal injection. The patient recovered well, except for a surgical wound infection that was treated with vacuum therapy...
2016: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/27341355/clinical-chronic-pancreatitis
#11
Walter G Park
PURPOSE OF REVIEW: To summarize observations in clinical chronic pancreatitis in the past year. RECENT FINDINGS: A predisposing genetic mutation was identified in 67% of cases of pediatric chronic pancreatitis. A novel susceptibility gene involving a hybrid allele is associated with idiopathic chronic pancreatitis. ABO blood type B and FUT2 nonsecretor status is associated with asymptomatic hyperlipasemia and chronic pancreatitis. Alcohol consumption impairs cystic fibrosis transmembrane conductance regulator (CFTR) activity leading to decreased bicarbonate secretion and patients with susceptible CFTR mutations can develop clinical pancreatitis...
June 22, 2016: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/27207476/surgical-approaches-to-chronic-pancreatitis-indications-and-imaging-findings
#12
REVIEW
Nima Hafezi-Nejad, Vikesh K Singh, Stephen I Johnson, Martin A Makary, Kenzo Hirose, Elliot K Fishman, Atif Zaheer
Chronic pancreatitis (CP) is an irreversible, inflammatory process characterized by progressive fibrosis of the pancreas that can result in abdominal pain, exocrine insufficiency, and diabetes. Inadequate pain relief using medical and/or endoscopic therapies is an indication for surgery. The surgical management of CP is centered around three main operations including pancreaticoduodenectomy (PD), duodenum-preserving pancreatic head resection (DPPHR) and drainage procedures, and total pancreatectomy with islet autotransplantation (TPIAT)...
October 2016: Abdominal Radiology
https://www.readbyqxmd.com/read/27137483/metastatic-pancreatic-adenocarcinoma-after-total-pancreatectomy-islet-autotransplantation-for-chronic-pancreatitis
#13
S Muratore, X Zeng, M Korc, S McElyea, J Wilhelm, M Bellin, G Beilman
Total pancreatectomy with islet autotransplantation (TPIAT) is being used increasingly as a definitive treatment for chronic pancreatitis. Patients with chronic pancreatitis have an elevated risk of pancreatic cancer, which can also masquerade as acute or chronic pancreatitis, making the diagnosis challenging. We describe here the first case of pancreatic ductal adenocarcinoma developing in the liver of a patient after TPIAT for presumed benign chronic pancreatitis. Retrospective analysis of the patient's preoperative serum revealed normal carbohydrate antigen 19-9 and carcinoembryonic antigen levels but elevated levels of microRNAs -10b, -30c, and -106b compared with controls...
September 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27134135/microbial-contamination-of-transplant-solutions-during-pancreatic-islet-autotransplants-is-not-associated-with-clinical-infection-in-a-pediatric-population
#14
Megan G Berger, Kaustav Majumder, James S Hodges, Melena D Bellin, Sarah Jane Schwarzenberg, Sameer Gupta, Ty B Dunn, Gregory J Beilman, Timothy L Pruett, Martin L Freeman, Joshua J Wilhelm, David E R Sutherland, Srinath Chinnakotla
BACKGROUND/OBJECTIVES: Total pancreatectomy and islet autotransplant (TP-IAT) is a potential treatment for children with severe refractory chronic pancreatitis. Cultures from the resected pancreas and final islet preparation are frequently positive for microbes. It is unknown whether positive cultures are associated with adverse outcomes in pediatric patients. METHODS: We reviewed the medical records of children (n = 86) who underwent TP-IAT from May 2006-March 2015 with emphasis on demographics, previous pancreatic interventions, culture results, islet yield, hospital days, posttransplant islet function, and posttransplant infections...
July 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/27122666/total-pancreatectomy-with-islet-cell-transplantation-vs-intrathecal-narcotic-pump-infusion-for-pain-control-in-chronic-pancreatitis
#15
Mohamad Mokadem, Lama Noureddine, Thomas Howard, Lee McHenry, Stuart Sherman, Evan L Fogel, James L Watkins, Glen A Lehman
AIM: To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump infusion. METHODS: We recognized 13 patients who underwent intrathecal narcotic pump (ITNP) infusion and 57 patients who underwent total pancreatectomy with autologous islet cell transplantation (TP + ICT) for chronic pancreatitis (CP) pain control between 1998 and 2008 at Indiana University Hospital. All patients had already failed multiple other modalities for pain control and the decision to proceed with either intervention was made at the discretion of the patients and their treating physicians...
April 28, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/27105121/accuracy-of-continuous-glucose-monitoring-in-patients-after-total-pancreatectomy-with-islet-autotransplantation
#16
Gregory P Forlenza, Brandon M Nathan, Antoinette Moran, Ty B Dunn, Gregory J Beilman, Timothy L Pruett, Boris P Kovatchev, Melena D Bellin
BACKGROUND: Among postsurgical and critically ill patients, malglycemia is associated with increased complications. Continuous glucose monitoring (CGM) in the inpatient population may enhance glycemic control. CGM reliability may be compromised by postsurgical complications such as edema or vascular changes. We utilized Clarke Error Grid (CEG) and Surveillance Error Grid (SEG) analysis to evaluate CGM performance after total pancreatectomy with islet autotransplantation. MATERIALS AND METHODS: This subanalysis evaluated Medtronic Enlite 2 CGM values against YSI serum glucose in seven post-transplant patients (86% female; 38...
August 2016: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/26878183/hereditary-pancreatitis
#17
Edgardo D Rivera Rivera, Ankur Chugh, Jonathon Cordova, Sona Young
A 13-year-old boy with a strong family history of hereditary pancreatitis was found to have a PRSS1 mutation after being tested at age 5 years during his first documented incident of pancreatitis. Since then, a multidisciplinary team has been treating him for the diagnosis of hereditary pancreatitis. His pain episodes increased in severity over the past several months such that the pain began to severely interfere with his daily life. After extensive discussion, a total pancreatectomy with auto islet cell transplant was performed...
February 2016: Pediatric Annals
https://www.readbyqxmd.com/read/26593636/pancreatic-islet-autotransplantation-for-nonmalignant-and-malignant-indications
#18
REVIEW
Yvette C Tanhehco, Stuart Weisberg, Joseph Schwartz
The standard therapy for patients with chronic pancreatitis (CP) and severe abdominal pain is total pancreatectomy (TP) followed by islet autotransplantation (IAT) to prevent the development of brittle diabetes. In adult patients, narcotic independence is achieved in up to 73% of patients 1 to 5 years after transplantation whereas insulin independence is achieved in up to 40% of patients 1 to 2 years after transplantation. Pediatric patients have shown similar outcomes for narcotic independence (up to 79%) but better outcomes for insulin independence (up to 56% 1 year after transplantation)...
March 2016: Transfusion
https://www.readbyqxmd.com/read/26588810/successful-application-of-closed-loop-artificial-pancreas-therapy-after-islet-autotransplantation
#19
RANDOMIZED CONTROLLED TRIAL
G P Forlenza, B M Nathan, A M Moran, T B Dunn, G J Beilman, T L Pruett, M D Bellin
Total pancreatectomy with islet autotransplantation (TPIAT) may relieve the pain of chronic pancreatitis while avoiding postsurgical diabetes. Minimizing hyperglycemia after TPIAT limits beta cell apoptosis during islet engraftment. Closed-loop (CL) therapy combining an insulin pump with a continuous glucose monitor (CGM) has not been investigated previously in islet transplant recipients. Our objective was to determine the feasibility and efficacy of CL therapy to maintain glucose profiles close to normoglycemia following TPIAT...
February 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/26275441/pediatric-autologous-islet-transplantation
#20
REVIEW
Melena D Bellin, Sarah J Schwarzenberg, Marie Cook, David E R Sutherland, Srinath Chinnakotla
A total pancreatectomy and islet autotransplant (TPIAT) offers substantial pain relief and improved quality of life for children who are severely affected by chronic or recurrent acute pancreatitis and for whom the usual medical and endoscopic therapies have failed. The pancreas is entirely resected, and the pancreatic islets are isolated from the pancreas and infused back into the patient's liver. Because this is an autologous transplant, no immunosuppression is required. Over several months, the islets engraft in the liver; the patient is then slowly weaned off insulin therapy...
October 2015: Current Diabetes Reports
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