Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest.

Melena D Bellin, Martin L Freeman, Andres Gelrud, Adam Slivka, Alfred Clavel, Abhinav Humar, Sarah J Schwarzenberg, Mark E Lowe, Michael R Rickels, David C Whitcomb, Jeffrey B Matthews, Stephen Amann, Dana K Andersen, Michelle A Anderson, John Baillie, Geoffrey Block, Randall Brand, Suresh Chari, Marie Cook, Gregory A Cote, Ty Dunn, Luca Frulloni, Julia B Greer, Michael A Hollingsworth, Kyung Mo Kim, Alexander Larson, Markus M Lerch, Tom Lin, Thiruvengadam Muniraj, R Paul Robertson, Seth Sclair, Shalinender Singh, Rachelle Stopczynski, Frederico G S Toledo, Charles Melbern Wilcox, John Windsor, Dhiraj Yadav

Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2014;14(1):27-35

PMID: 24555976

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Abstract

DESCRIPTION

Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure used to treat severe complications of chronic pancreatitis or very high risk of pancreatic cancer while reducing the risk of severe diabetes mellitus. However, clear guidance on indications, contraindications, evaluation, timing, and follow-up are lacking.

METHODS

A working group reviewed the medical, psychological, and surgical options and supporting literature related to TPIAT for a consensus meeting during PancreasFest.

RESULTS

Five major areas requiring clinical evaluation and management were addressed: These included: 1) indications for TPIAT; 2) contraindications for TPIAT; 3) optimal timing of the procedure; 4) need for a multi-disciplinary team and the roles of the members; 5) life-long management issues following TPIAP including diabetes monitoring and nutrition evaluation.

CONCLUSIONS

TPIAT is an effective method of managing the disabling complications of chronic pancreatitis and risk of pancreatic cancer in very high risk patients. Careful evaluation and long-term management of candidate patients by qualified multidisciplinary teams is required. Multiple recommendations for further research were also identified.

Address: Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. Electronic address: [email protected].; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.; Department of Medicine, University of Chicago, Chicago, IL, USA.; Department of Medicine, University of Pittsburgh, PA, USA.; Department of Neurology, University of Minnesota, Minneapolis, MN, USA.; Department of Surgery, University of Pittsburgh, PA, USA.; Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.; Department of Pediatrics, University of Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, PA, USA.; Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.; Department of Medicine, University of Pittsburgh, PA, USA. Electronic address: [email protected].; Department of Surgery, University of Chicago, Chicago, IL, USA.

DOI: 10.1016/j.pan.2013.10.009

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MeSH Terms: Contraindications, Humans, Islets of Langerhans Transplantation, Pancreatectomy, Pancreatic Neoplasms, Pancreatitis, Chronic, Risk, Transplantation, Autologous