全胰切除术后胰岛自体移植的结果：一项欧洲单中心研究。
Outcome after total pancreatectomy with islet autotransplantation: A European single-center study.
机构信息
Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Disease, Karolinska University Hospital, 14186 Stockholm, Sweden.
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden.
出版信息
Scand J Surg. 2024 Jun;113(2):80-87. doi: 10.1177/14574969231220176. Epub 2023 Dec 25.
BACKGROUND AND AIMS
Chronic pancreatitis may cause intractable abdominal pain, with total pancreatectomy sometimes being the last resort. To mitigate the subsequent diabetes, total pancreatectomy can be followed by islet autotransplantation (TP-IAT). The primary aim of this study was to assess the outcomes in patients undergoing TP-IAT at Karolinska University Hospital with respect to safety, postoperative complications, and islet graft function. A secondary aim was to compare liver to skeletal muscle as autotransplantation sites.
METHODS
Single-center observational cohort study on patients undergoing TP-IAT. Islets were transplanted either into the liver or skeletal muscle. Data on baseline characteristics and pretransplantory conditions were collected. Outcome measures included mortality and major postoperative complications as well as the glycemic measures: insulin use, fasting C-peptide, and HbA1c.
RESULTS
Between 2004 and 2020, 24 patients underwent TP-IAT. Islets were transplanted into the liver in 9 patients and into skeletal muscle in 15 patients. There was no 90-day mortality, and major complications (Clavien-Dindo ⩾IIIa) occurred in 26.7%, all related to the procedure of total pancreatectomy. Fasting C-peptide could be detected postoperatively, with higher levels in patients receiving islet autotransplantation into the liver (p = 0.006). Insulin independence was not achieved, although insulin doses at last follow-up were significantly lower in patients receiving islet autotransplantation into the liver compared to skeletal muscle (p = 0.036).
CONCLUSION
TP-IAT is safe and associated with tolerable risk, the component of islet autotransplantation being seemingly harmless. Although islet grafts maintain some endocrine function, insulin independence should not be expected. Regarding islet autotransplantation sites, the liver seems superior to skeletal muscle.
CLINICAL TRIAL REGISTRATION
Not applicable.
背景与目的
慢性胰腺炎可能导致难以缓解的腹痛，全胰切除术有时是最后的治疗手段。为了减轻随后发生的糖尿病，全胰切除术后可以进行胰岛自体移植（TP-IAT）。本研究的主要目的是评估在卡罗林斯卡大学医院接受 TP-IAT 的患者的安全性、术后并发症和胰岛移植物功能。次要目的是比较肝和骨骼肌作为自体移植部位。
方法
对在卡罗林斯卡大学医院接受 TP-IAT 的患者进行单中心观察性队列研究。胰岛被移植到肝脏或骨骼肌中。收集基线特征和移植前条件的数据。主要观察指标包括死亡率和主要术后并发症以及血糖测量指标：胰岛素使用、空腹 C 肽和 HbA1c。
结果
2004 年至 2020 年期间，有 24 例患者接受了 TP-IAT。胰岛移植到肝脏的患者有 9 例，移植到骨骼肌的患者有 15 例。90 天内无死亡，26.7%的患者发生主要并发症（Clavien-Dindo ⩾IIIa），均与全胰切除术有关。术后可检测到空腹 C 肽，接受肝内胰岛自体移植的患者 C 肽水平更高（p=0.006）。虽然在最后一次随访时，接受肝内胰岛自体移植的患者的胰岛素剂量明显低于接受骨骼肌移植的患者，但并未实现胰岛素独立性（p=0.036）。
结论
TP-IAT 是安全的，风险可耐受，胰岛自体移植的部分似乎没有危害。尽管胰岛移植物保持一定的内分泌功能，但不应期望达到胰岛素独立性。关于胰岛自体移植部位，肝脏似乎优于骨骼肌。
临床试验注册
不适用。
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