Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach

AbstractBackgroundIn 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.MethodsA 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).ResultsThirty-six patients (28 women; median age 48years) underwent pancreatectomy with P-IAT. Median operative time was 232min (range: 98–395min) and median estimated blood loss was 500cc (range: 75–3000cc). Median time from pancreatic resection to islet transplantation was 269min (range: 145–361min). A median of 208248 IEq (2298IEq/kg) were harvested. Median peak portal venous pressure during islet infusion was 13mmHg (range: 5–37mmHg). 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 >30mmHg. At a median follow-up of 10.7months, eight patients (22%) were insulin-free. Median pertinent charges for P-IAT were US$36318 and estimated median charges for I-IAT were US$56440. Surgeon time freed by P-IAT facilitated an additional 66 procedures, charges for which amounted to US$463375.ConclusionsPercutaneous 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