Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation

Abstract EN

Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function.

Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive.

In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield, and post-TPIAT glucose management data to further understand their relationship.

Islet yield, glucose level, and insulin requirement for 72 hours postoperatively were collected for a total of 13 TPIAT recipients between 9-2013 and 9-2018.

In addition, their glucose control and basal insulin requirements at 3, 6, and 12 months post-TPIAT were analyzed.

All 13 subjects had normal baseline fasting glucose levels.

Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987).

Median postoperative total insulin requirement on day 3 was 0.43 units/kg.

Pre-TPIAT baseline glucose, insulin, or c-peptide level did not have a significant correlation with the islet yield.

Similarly, there was no correlation between islet yield and insulin requirement at 72-hour postoperatively.

However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT.

Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6, and 12 months showed a positive correlation.

Despite the finding of inverse correlation of islet yield with long-term basal insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies.

The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long-term insulin management following TPIAT.

This observation may identify a high-risk group of patients in need of more intensive diabetes education and insulin treatment prior to hospital discharge.