Impact of microbial contamination of the islet product during total pancreatectomy with islet autotransplantation

Kenjiro Kumano; Morihito Takita; Srividya Vasu; Carly Darden; Michael Lawrence; Ernest Beecherl; Amar Gupta; Nicholas Onaca; Bashoo Naziruddin

doi:10.1002/jhbp.709

Impact of microbial contamination of the islet product during total pancreatectomy with islet autotransplantation

J Hepatobiliary Pancreat Sci. 2020 Apr;27(4):211-218. doi: 10.1002/jhbp.709. Epub 2020 Feb 12.

Authors

Kenjiro Kumano¹, Morihito Takita¹, Srividya Vasu¹, Carly Darden², Michael Lawrence¹, Ernest Beecherl³, Amar Gupta³, Nicholas Onaca³, Bashoo Naziruddin³

Affiliations

¹ Baylor Scott and White Research Institute, Dallas, TX, USA.
² Baylor University, Waco, TX, USA.
³ Baylor Simmons Transplant Institute, Dallas, TX, USA.

PMID: 31944603
DOI: 10.1002/jhbp.709

Abstract

Background: The combined use of interleukin-1β and tumor necrosis factor-α blockers in the peritransplant period has improved outcomes of total pancreatectomy with islet autotransplantation (TPIAT). However, these drugs may suppress the immune system, resulting in severe infection.

Methods: We retrospectively investigated the impact of microbial-contaminated islet product on posttransplant complications and metabolic outcomes of TPIAT patients receiving the IL-1β and TNF-blockade treatment at our center.

Results: Among 108 TPIAT patients, 37 patients (34%) received contaminated products. Preoperative stent treatment and fibrosis score were independent risk factors for the contamination. There were no significant differences between the contaminated and noncontaminated product groups in posttransplant infectious complication rate, length of hospitalization, or readmission rate. However, islet equivalents (P < .0001) and insulin independence rate (P = .036) at 6 months were significantly lower for patients receiving contaminated product.

Conclusions: These results suggest that combined anti-inflammatory drug use is safe and well tolerated in TPIAT patients who receive contaminated islet product and does not increase the rate of infectious complications; however, contaminated islet product is associated with poor metabolic outcomes.

Keywords: bacterial contamination; complication; fibrosis; immunosuppression; islet transplantation.

MeSH terms

Adolescent
Adult
Aged
Anti-Bacterial Agents / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Bacterial Infections / chemically induced
Bacterial Infections / etiology*
Bacterial Infections / microbiology
C-Peptide / blood
Etanercept / adverse effects
Etanercept / therapeutic use
Female
Glycated Hemoglobin / analysis
Glycated Hemoglobin / metabolism
Humans
Hypoglycemic Agents / therapeutic use
Immunosuppressive Agents / adverse effects
Immunosuppressive Agents / therapeutic use
Insulin / therapeutic use
Interleukin 1 Receptor Antagonist Protein / adverse effects
Interleukin 1 Receptor Antagonist Protein / therapeutic use
Interleukin-1beta / antagonists & inhibitors
Islets of Langerhans / microbiology*
Islets of Langerhans Transplantation / adverse effects*
Islets of Langerhans Transplantation / methods
Male
Middle Aged
Pancreatectomy / adverse effects
Pancreatectomy / methods*
Pancreatitis, Chronic / blood
Pancreatitis, Chronic / etiology
Pancreatitis, Chronic / metabolism
Pancreatitis, Chronic / surgery*
Retrospective Studies
Risk Factors
Transplantation, Autologous / adverse effects*
Treatment Outcome
Tumor Necrosis Factor-alpha / antagonists & inhibitors
Young Adult

Substances

Anti-Bacterial Agents
Anti-Inflammatory Agents, Non-Steroidal
C-Peptide
Glycated Hemoglobin A
Hypoglycemic Agents
Immunosuppressive Agents
Insulin
Interleukin 1 Receptor Antagonist Protein
Interleukin-1beta
Tumor Necrosis Factor-alpha
hemoglobin A1c protein, human
Etanercept