2023-LB: Type 2 or Type 3c Diabetes Not an Exclusion Criteria for Total Pancreatectomy with Islet Auto Transplantation (TPIAT)

Purpose: Total pancreatectomy with islet auto-transplantation (TPIAT) is now a standard of care for patients with severe chronic pancreatitis. However, evaluation and patient selection is necessary to benefit from this difficult procedure. Several patients with CP also have underlying diabetes, Type 2 or type 3c. In this study, we performed a comparative analysis of the outcomes of the TPIAT procedure between our pre-transplant diabetic and non-diabetic patient cohorts.

Methods: A total of 100 Patients who underwent TPIAT at Virginia Commonwealth University from June 2016 to March 2024 have been included in this study. 26 out of 100 patients were diabetic before undergoing TPIAT and were either insulin-dependent or under other diabetic medications and with an HbA1c of more than 6.0%. Islet isolation outcomes were compared along with metabolic outcomes and pain management data at clinical time points post-transplantation. Maintenance of hypoglycemic awareness was also assessed in these patients.

Results: Islet yields in diabetic and non-diabetic patients undergoing transplantation were significantly different (Diabetic vs. Non-Diabetic; 158362±185600 vs. 345126±219809; P<0.05). All Patients that were diabetic before TPIAT procedure continued to be insulin-dependent, whereas 40% of non-diabetic patients became insulin-independent at 1-year post-transplantation. Most interestingly, narcotic dependence was reduced in more than 50% at 1 year in patients with diabetes which was similar to patients who were non-diabetic. Similarly, pain scores were also reduced in patients equally regardless of their diabetic status prior to transplantation.

Conclusion: Pre-transplant diabetes should not be considered as a contra-indication for TPIAT, as these patients can maintain hypoglycemic awareness after transplantation of islets which is a major benefit along with relief from narcotic dependence.