Diffuse calcification of pancreas impairs endocrine function and predicts poor outcome in total pancreatectomy with islet autotransplantation

• Published in: American journal of transplantation Vol. 23; no. 11; pp. 1781 - 1792
• Main Authors: Darden, Carly, Kumano, Kenjiro, Liu, Yang, Asim, Mohammed, Mattke, Jordan, Lawrence, Michael, Gupta, Amar, Beecherl, Ernest, Lee, Seung Hee S., Naziruddin, Bashoo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2023
• Subjects: autotransplantation; islet transplantation; chronic pancreatitis; graft function
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1016/j.ajt.2023.07.012

In patients with chronic pancreatitis, pancreatic calcification is a risk factor for diabetes development, poor islet yield, and metabolic outcomes after total pancreatectomy with islet autotransplantation (TPIAT). We investigated whether calcification pattern based on computed tomography is associated with outcomes using our database of 200 consecutive TPIAT procedures. Three groups were compared: noncalcification (NC); focal calcification (FC), limited to the pancreas head, body, or tail; and diffuse calcification (DC), with calcification in >2 sections. Maximum changes in outcomes were seen in the DC vs FC group. In the DC group, preoperative hemoglobin A1c levels were higher (P < 0.01) and stimulated C-peptide levels were lower (P < 0.01) than in the NC group. Islet isolation from the DC pancreas resulted in the lowest islet yield (IEQ) and IEQ/kg among the three groups (P < 0.0001) with no insulin independence 12 months posttransplant (P < 0.05 vs NC). Notably, at 12 months, the DC group was 91.7% narcotic free, significantly higher than the NC group (P < 0.05). Although DC is a sign of diabetes risk after TPIAT, the DC group showed exceptional pain relief. These findings suggest that TPIAT can be beneficial for patients with chronic pancreatitis with severe calcification.