Glycemic Outcomes of Islet Autotransplantation

AbstractPurpose of ReviewWhile there has been a growing utilization of total pancreatectomy with islet autotransplantation (TPIAT) for patients with medically refractory chronic pancreatitis over the past few decades, there remains a lack of consensus clinical guidelines to inform the counseling and management of patients undergoing TPIAT. In this article, we review the current clinical practice and published experience of several TPIAT centers, outline key aspects in managing patients undergoing TPIAT, and discuss the glycemic outcomes of this procedure.Recent FindingsAiming for lower inpatient glucose targets immediately after surgery (usually 100 –120 mg/dl), maintaining all patients on subcutaneous insulin for at least 3 months to “rest” islets before an attempt is made to wean insulin, and close outpatient endocrinology follow-up after TPIAT particularly in the first year is common and related to better outcomes. Although TPIAT pro cedures and glycemic outcomes may differ across surgical centers, overall, approximately one third of patients are insulin independent at 1 year after TPIAT. Higher islet yield and lower preoperative glucose levels are among the strongest predictors of short-term post-operative insulin independence . Beyond 1 year post-operatively, the clinical management and long-term glycemic outcomes of patients after TPIAT are more variable.SummaryA multidisciplinary approach is essential in optimizing the preoperative, inpatient, and post-operat...
Source: Current Diabetes Reports - Category: Endocrinology Source Type: research