这项研究的目的是确定胰岛细菌污染是否会影响胰岛自体移植(TPIAT)全胰腺切除术后的移植物成功。
TPIAT后与胰岛素独立性相关的因素尚无定论。虽然细菌污染并不妨碍移植,细菌污染对移植成功的影响尚不清楚.
对2007年1月至2016年1月在弗吉尼亚大学接受TPIAT治疗的患者进行了回顾。对患者图表进行细菌污染审查,并前瞻性地联系患者以评估胰岛素独立率。
实现胰岛素独立的患者和未实现胰岛素独立的患者在人口统计学或围手术期数据上没有显著差异。然而,分析的27例患者中有6例(22.2%)从最终胰岛制剂的培养物中产生细菌污染物.在最近的随访中,这些患者的胰岛产量和C肽明显较低(P<0.05)。这些患者均未实现胰岛素独立。
胰岛移植溶液通常是培养阳性,可能是继发于采购前胰腺操纵和肠道菌群引入。尽管培养阳性胰岛的自体移植是安全的,它与较高的移植物失败率和较差的胰岛产量有关。应考虑确定可能发展为难治性慢性胰腺炎的患者,并提供早期手术治疗以防止细菌定植。
The purpose of this study was to determine whether bacterial contamination of islets affects graft success after total pancreatectomy with islet autotransplantation (TPIAT).
Factors associated with insulin independence after TPIAT are inconclusive. Although bacterial contamination does not preclude transplantation, the impact of bacterial contamination on graft success is unknown.
Patients who received TPIAT at the University of Virginia between January 2007 and January 2016 were reviewed. Patient charts were reviewed for bacterial contamination and patients were prospectively contacted to assess rates of insulin independence.
There was no significant difference in demographic or perioperative data between patients who achieved insulin independence and those who did not. However, six of 27 patients analyzed (22.2%) grew bacterial contaminants from culture of the final islet preparations. These patients had significantly lower islet yield and C-peptide at most recent follow-up (P<.05), and none of these patients achieved insulin independence.
Islet transplant solutions are often culture positive, likely secondary to preprocurement pancreatic manipulation and introduction of enteric flora. Although autotransplantation of culture-positive islets is safe, it is associated with higher rates of graft failure and poor islet yield. Consideration should be given to identify patients who may develop refractory chronic pancreatitis and offer early operative management to prevent bacterial colonization.