Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Autotransplant
Background. Total pancreatectomy with islet autotransplantation (TPIAT) requires a complex islet isolation process of the explanted pancreas. Islet isolation has historically required a specialized laboratory to perform islet isolation. We report our experience with a novel technique of intraoperati...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-05-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001314 |
| _version_ | 1828473615666905088 |
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| author | Christopher M. Navas, MD Kerrington D. Smith, MD Sushela S. Chaidarun, MD, PhD Dawn A. Fischer, BS Timothy B. Gardner, MD, MS |
| author_facet | Christopher M. Navas, MD Kerrington D. Smith, MD Sushela S. Chaidarun, MD, PhD Dawn A. Fischer, BS Timothy B. Gardner, MD, MS |
| author_sort | Christopher M. Navas, MD |
| collection | DOAJ |
| description | Background. Total pancreatectomy with islet autotransplantation (TPIAT) requires a complex islet isolation process of the explanted pancreas. Islet isolation has historically required a specialized laboratory to perform islet isolation. We report our experience with a novel technique of intraoperative islet isolation that does not require a specialized islet laboratory, thereby making the isolation process simpler, more accessible, and less costly.
Methods. We performed a retrospective, comparative effectiveness analysis of 50 adult patients who underwent TPIAT from 2012 to 2020 (TPIAT with remote isolation [n = 20] versus intraoperative isolation of islet cells [n = 30]). The primary outcome was islet equivalents per body weight (IEQ/kg) for patients in each group.
Results. Mean IEQ/kg‘s (4294 remote group versus 3015 intraoperative group, P = 0.06) and 1-y postoperative C-peptide levels (1.51 ng/mL remote group versus 0.91 ng/mL intraoperative group, P = 0.10) were not different between groups. Mean 1-y HbA1c levels (7.7% in the remote group versus 7.1% intraoperative group, P = 0.67) and 1-y insulin requirements (P = 0.31) were not statistically different. Lower average cost of hospitalization was seen in the intraoperative group, although this was not statistically significant ($104 398 remote versus $78 986 intraoperative, P = 0.81).
Conclusions. Intraoperative islet isolation has similar effectiveness in regard to glycemic outcomes compared with the use of a dedicated islet cell isolation laboratory at a lower cost. |
| first_indexed | 2024-12-11T05:47:06Z |
| format | Article |
| id | doaj.art-b958997dc11b48999e4a2d6667c15eb3 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-11T05:47:06Z |
| publishDate | 2022-05-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-b958997dc11b48999e4a2d6667c15eb32022-12-22T01:18:56ZengWolters KluwerTransplantation Direct2373-87312022-05-0185e131410.1097/TXD.0000000000001314202205000-00003Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet AutotransplantChristopher M. Navas, MD0Kerrington D. Smith, MD1Sushela S. Chaidarun, MD, PhD2Dawn A. Fischer, BS3Timothy B. Gardner, MD, MS41 Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.2 Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.3 Section of Endocrinology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.2 Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.1 Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.Background. Total pancreatectomy with islet autotransplantation (TPIAT) requires a complex islet isolation process of the explanted pancreas. Islet isolation has historically required a specialized laboratory to perform islet isolation. We report our experience with a novel technique of intraoperative islet isolation that does not require a specialized islet laboratory, thereby making the isolation process simpler, more accessible, and less costly. Methods. We performed a retrospective, comparative effectiveness analysis of 50 adult patients who underwent TPIAT from 2012 to 2020 (TPIAT with remote isolation [n = 20] versus intraoperative isolation of islet cells [n = 30]). The primary outcome was islet equivalents per body weight (IEQ/kg) for patients in each group. Results. Mean IEQ/kg‘s (4294 remote group versus 3015 intraoperative group, P = 0.06) and 1-y postoperative C-peptide levels (1.51 ng/mL remote group versus 0.91 ng/mL intraoperative group, P = 0.10) were not different between groups. Mean 1-y HbA1c levels (7.7% in the remote group versus 7.1% intraoperative group, P = 0.67) and 1-y insulin requirements (P = 0.31) were not statistically different. Lower average cost of hospitalization was seen in the intraoperative group, although this was not statistically significant ($104 398 remote versus $78 986 intraoperative, P = 0.81). Conclusions. Intraoperative islet isolation has similar effectiveness in regard to glycemic outcomes compared with the use of a dedicated islet cell isolation laboratory at a lower cost.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001314 |
| spellingShingle | Christopher M. Navas, MD Kerrington D. Smith, MD Sushela S. Chaidarun, MD, PhD Dawn A. Fischer, BS Timothy B. Gardner, MD, MS Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Autotransplant Transplantation Direct |
| title | Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Autotransplant |
| title_full | Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Autotransplant |
| title_fullStr | Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Autotransplant |
| title_full_unstemmed | Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Autotransplant |
| title_short | Effectiveness of Intraoperative Versus Dedicated Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Autotransplant |
| title_sort | effectiveness of intraoperative versus dedicated islet cell laboratory isolation for total pancreatectomy with islet autotransplant |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001314 |
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