Select your timezone:

Poster Session

Thursday October 26, 2023 - 16:30 to 18:00

Room: Foyer Area

P.24 Islet alloautotransplantation six years after simultaneous pancreas and kidney transplantation

Diego Cantarovich, France

Professor of Neohrology
ITUN, Nantes University Hospital
University Hospital of Nantes


Islet alloautotransplantation six years after simultaneous pancreas and kidney transplantation

Delphine Kervella1, Mickael Chetboun2, Julie Kerr-Conte3, Georges Karam4, Pascale Mahot-Moreau5, François Pattou2, Diego Cantarovich1.

1Néphrologie et Immunologie Clinique, CHU de Nantes, Nantes, France; 2Chirurgie générale et endocrinienne, CHU de Lille, Lille, France; 3INSERM Unit 1190, Université de Lille, Lille, France; 4Service d'urologie, CHU de Nantes, Nantes, France; 5Service d'endocrinologie, CHU de Nantes, Nantes, France

We describe the case of a 46-years old man suffering from type 1 diabetes (T1D) complicated by end-stage renal disease and severe diabetic retinopathy. A simultaneous pancreas and kidney transplantation was performed with enteric drainage (latero-lateral anastomosis between graft duodenum and a jejunal loop). Both graft functions were satisfactory under triple immunosuppression. Three years posttransplant he experienced an occlusive syndrome due to an internal hernia, requiring partial ileal resection.

Six years posttransplant he was admitted with occlusive syndrome secondary to an internal hernia, with extended ischemia with necrosis of the small bowel. A resection of small intestine was performed, including the duodenal graft anastomosis, followed by a jejuno-ileal anastomosis. The pancreas graft exocrine secretions drainage was handled by placing a drain in the remaining duodenal segment. An unexpected mobilization of the pancreatic drain led to a pancreatic fistula. It was technically not possible to perform a new enteric anastomosis, nor a bladder drainage. An islet transplantation was considered as pancreas allograft endocrine function was preserved (no insulin need). The pancreas was surgically retrieved, the same day the islets were isolated and injected into the mesenteric vein. The patient was maintained on triple immunosuppressive therapy. During postoperative care, insulin therapy was needed. Nine months after islet auto-allo-transplantation, glycemic control requires 20 to 25 insulin units a day with a significative endogeneous insulin secretion (fasting c-peptide 0.83 ng/mL) and the absence of severe hypoglycemia, thus considered as partial graft function.

Internal hernias are rare but described complications of pancreas transplantation with enteric drainage1. Unfortunately in our patient the hernia was complicated by necrosis of the graft duodenal anastomosis, and subsequent resection induced the removal of exocrine drainage, however endocrine function was maintained. Islet autotransplantation is a procedure performed in patients undergoing surgery for chronic pancreatitis and also increasingly for pancreas malignancies2. Insulin-independence rate after total pancreatectomy and islet autotransplantation has been reported around 25-30% at one year in these patients that had for the majority no insulin requirement before surgery2,3. Factors influencing glycemic outcomes are abnormal glycemia or HbA1c before transplantation and islet yield4. One study reported 27% insulin-independence at 5 years, with stable insulin requirement similar to those of our patient5. The impact of performing an auto-transplantation on the occurrence of long-term diabetes complication have not been evaluated. In our case, we can assume some degree of fibrosis of the graft, lowering the islet yield. However, despite a suboptimal islet function and in this situation of continued immunosuppression (because of the renal graft), we assume that this strategy can be beneficial to maintain a degree of endogenous insulin secretion and avoid severe hypoglycemia6


[1] 1. Agarwal A, Maglinte DDT, Goggins WC, Milgrom ML, Pescovitz MD, Fridell JA. Internal Hernia after Pancreas Transplantation with Enteric Drainage: An Unusual Cause of Small Bowel Obstruction. Transplantation. 2005;80(1):149-152. doi:10.1097/01.TP.0000162983.59042.E9
[2] 2. Balzano G, Maffi P, Nano R, et al. Autologous Islet Transplantation in Patients Requiring Pancreatectomy: A Broader Spectrum of Indications Beyond Chronic Pancreatitis. Am J Transplant. 2016;16(6):1812-1826. doi:10.1111/ajt.13656
[3] 3. Kempeneers MA, Scholten L, Verkade CR, et al. Efficacy of total pancreatectomy with islet autotransplantation on opioid and insulin requirement in painful chronic pancreatitis: A systematic review and meta-analysis. Surgery. 2019;166(3):263-270. doi:10.1016/j.surg.2019.03.014
[4] 4. Nanno Y, Wastvedt S, Freeman ML, et al. Metabolic measures before surgery and long-term diabetes outcomes in recipients of total pancreatectomy and islet autotransplantation. American Journal of Transplantation. 2021;21(10):3411-3420. doi:10.1111/ajt.16573
[5] 5. Wilson GC, Sutton JM, Abbott DE, et al. Long-Term Outcomes After Total Pancreatectomy and Islet Cell Autotransplantation: Is It a Durable Operation? Annals of Surgery. 2014;260(4):659-667. doi:10.1097/SLA.0000000000000920
[6] 6. Rickels MR, Stock PG, Koning EJP de, et al. Defining outcomes for β‐cell replacement therapy in the treatment of diabetes: a consensus report on the Igls criteria from the IPITA/EPITA opinion leaders workshop. Transplant International. 2018;31(4):343-352. doi:10.1111/tri.13138

Organized by

Supported by

Hosted by

IPITA-IXA-CTRMS Joint Congress • San Diego, CA, USA • October 26-29, 2023
© 2024 IPITA-IXA-CTRMS 2023