Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection
Hepatic parenchymal disease, including chronic viral hepatitis, has traditionally been considered a relative contraindication to islet transplantation as the islets are infused into the recipient’s liver. We present a case study of a patient with treated chronic hepatitis C infection (HCV) who safel...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2018-10-01
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| Series: | Cell Transplantation |
| Online Access: | https://doi.org/10.1177/0963689718796772 |
| _version_ | 1818341894605766656 |
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| author | Amer Rajab Jill Buss Phil A. Hart Darwin Conwell Luis Lara Shumei Meng Kristin Kuntz Sylvester Black Ken Washburn |
| author_facet | Amer Rajab Jill Buss Phil A. Hart Darwin Conwell Luis Lara Shumei Meng Kristin Kuntz Sylvester Black Ken Washburn |
| author_sort | Amer Rajab |
| collection | DOAJ |
| description | Hepatic parenchymal disease, including chronic viral hepatitis, has traditionally been considered a relative contraindication to islet transplantation as the islets are infused into the recipient’s liver. We present a case study of a patient with treated chronic hepatitis C infection (HCV) who safely received an autologous islet transplant following total pancreatectomy with excellent clinical outcomes. The patient was a 60-year-old woman diagnosed with debilitating abdominal pain secondary to chronic pancreatitis and with preserved islet function. She had previously been treated >10 years prior to surgical evaluation with interferon monotherapy for 1 year that led to sustained virologic response, including at the time of surgical evaluation for total pancreatectomy and islet autotransplantation (TPIAT). She underwent comprehensive preoperative evaluation of the liver, including liver biopsy, which showed no significant portal inflammation or fibrosis. Following a multidisciplinary meeting and discussion of the potential risks for the patient, the decision was made to proceed with TPIAT. The patient underwent a standard total pancreatectomy, and an autologous islet dose of 6638 islet equivalents/kg body weight was infused into the liver via the portal vein. Portal vein pressure was monitored throughout the infusion with a transient peak pressure of 27 cm H 2 O (basal pressure of 14 cm H 2 O) and final pressure of 23 cm H 2 0 at 10 min post-infusion. Aside from a transient transaminitis, liver enzymes were normal at the time of hospital discharge. At greater than 1 year of follow-up, the patient has improved quality of life, with reduction in narcotic analgesia, remains insulin independent (with normal islet function), and has normal liver function. This case illustrates that islet autotransplant into the liver can be safely performed and suggests that carefully selected patients with liver disease may be eligible for TPIAT. |
| first_indexed | 2024-12-13T16:06:03Z |
| format | Article |
| id | doaj.art-c85510d23acf4c6db45f418c8108a49c |
| institution | Directory Open Access Journal |
| issn | 0963-6897 1555-3892 |
| language | English |
| last_indexed | 2024-12-13T16:06:03Z |
| publishDate | 2018-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Cell Transplantation |
| spelling | doaj.art-c85510d23acf4c6db45f418c8108a49c2022-12-21T23:39:03ZengSAGE PublishingCell Transplantation0963-68971555-38922018-10-012710.1177/0963689718796772Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C InfectionAmer Rajab0Jill Buss1Phil A. Hart2Darwin Conwell3Luis Lara4Shumei Meng5Kristin Kuntz6Sylvester Black7Ken Washburn8 Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, USA Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USAHepatic parenchymal disease, including chronic viral hepatitis, has traditionally been considered a relative contraindication to islet transplantation as the islets are infused into the recipient’s liver. We present a case study of a patient with treated chronic hepatitis C infection (HCV) who safely received an autologous islet transplant following total pancreatectomy with excellent clinical outcomes. The patient was a 60-year-old woman diagnosed with debilitating abdominal pain secondary to chronic pancreatitis and with preserved islet function. She had previously been treated >10 years prior to surgical evaluation with interferon monotherapy for 1 year that led to sustained virologic response, including at the time of surgical evaluation for total pancreatectomy and islet autotransplantation (TPIAT). She underwent comprehensive preoperative evaluation of the liver, including liver biopsy, which showed no significant portal inflammation or fibrosis. Following a multidisciplinary meeting and discussion of the potential risks for the patient, the decision was made to proceed with TPIAT. The patient underwent a standard total pancreatectomy, and an autologous islet dose of 6638 islet equivalents/kg body weight was infused into the liver via the portal vein. Portal vein pressure was monitored throughout the infusion with a transient peak pressure of 27 cm H 2 O (basal pressure of 14 cm H 2 O) and final pressure of 23 cm H 2 0 at 10 min post-infusion. Aside from a transient transaminitis, liver enzymes were normal at the time of hospital discharge. At greater than 1 year of follow-up, the patient has improved quality of life, with reduction in narcotic analgesia, remains insulin independent (with normal islet function), and has normal liver function. This case illustrates that islet autotransplant into the liver can be safely performed and suggests that carefully selected patients with liver disease may be eligible for TPIAT.https://doi.org/10.1177/0963689718796772 |
| spellingShingle | Amer Rajab Jill Buss Phil A. Hart Darwin Conwell Luis Lara Shumei Meng Kristin Kuntz Sylvester Black Ken Washburn Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection Cell Transplantation |
| title | Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection |
| title_full | Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection |
| title_fullStr | Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection |
| title_full_unstemmed | Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection |
| title_short | Total Pancreatectomy and Islet Autotransplantation Following Treated Hepatitis C Infection |
| title_sort | total pancreatectomy and islet autotransplantation following treated hepatitis c infection |
| url | https://doi.org/10.1177/0963689718796772 |
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