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MRI Prediction of Islet Yield for Autologous Transplantation After Total Pancreatectomy for Chronic Pancreatitis

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Abstract

Objective

The relationship between magnetic resonance imaging (MRI), histopathology, and islet yield was examined for chronic pancreatitis patients undergoing total pancreatectomy and autologous islet cell transplant (TP-AIT) to determine if the yield can be predicted by pre-operative MRI.

Methods

MRI sequences and histopathology were scored and compared for patients from whom ≤2,500 islet equivalents/kg were obtained with those from whom >2,500 islet equivalents/kg were obtained.

Results

Twenty patients, 14 female, mean age 40.20 ± 12.5 years, (range 19–63) underwent MRI before TP-AIT; mean 3,724 ± 891 islet equivalents/kg body weight, median 2,970, (range 76–17,770) were procured. There was no correlation between islet cell numbers and pancreas weight, HgbA1c, or c-peptide. The most common MRI sequence abnormality was the delayed interstitial phase, 14/18 (78 %). The other common MRI sequence abnormalities were, precontrast T1W 3D GRE sequence, 13/19 (68 %), and the arterial perfusion phase, 11/18 (61 %). The pancreatic duct was dilated in 10/20 (50 %). Parenchymal atrophy was noted in 10/20 (50 %). Median scores for individual MRI sequences were greater in patients with an islet cell yield of ≤2,500 islet equivalents/kg; for the delayed interstitial phase the difference was significant (median 2.5, range 1–3 versus median 0.5, range 0–3, P = 0.034). Histologically the most common feature was fibrosis, (17/17, 100 %); the score for fibrosis was greater for patients with an islet cell yield of ≤2,500 islet equivalents/kg (median 6.0, range 5–7 versus median 4.0, range 3–7, P = 0.024).

Conclusion

A diminished islet yield may be predicted on the basis of the delayed interstitial phase MRI sequence.

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Abbreviations

AIT:

Autologous islet transplant

CP:

Chronic pancreatitis

H &E:

Hematoxylin and eosin

MRI:

Magnetic resonance imaging

PV:

Portal vein

TP:

Total pancreatectomy

References

  1. Grigsby B, Rodriguez-Rilo H, Khan K. Antioxidants and chronic pancreatitis: theory of oxidative stress and trials of antioxidant therapy. Dig Dis Sci. 2012;57:835–841.

    Article  PubMed  CAS  Google Scholar 

  2. Rodriguez Rilo HL, Ahmad SA, D’Alessio D, et al. Total pancreatectomy and autologous islet cell transplantation as a means to treat severe chronic pancreatitis. J Gastrointest Surg. 2003;7:978–989.

    Article  PubMed  Google Scholar 

  3. Sohn TA, Campbell KA, Pitt HA, et al. Quality of life and long-term survival after surgery for chronic pancreatitis. J Gastrointest Surg. 2000;4:355–364.

    Article  PubMed  CAS  Google Scholar 

  4. Banks PA. Epidemiology, natural history, and predictors of disease outcomes in acute and chronic pancreatitis. Gastrointest Endosc. 2000;56:226–230.

    Article  Google Scholar 

  5. Morrison CP, Wemyss-Holden SA, Partensky C, Maddern GJ. Surgical management of intractable pain in chronic pancreatitis: past and present. J Hepatobiliary Pancreat Surg. 2002;9:675–682.

    Article  PubMed  Google Scholar 

  6. Berney T, Rudisuhli T, Oberholzer J, Caulfield A, Morel P. Long-term metabolic results after pancreatic resection for severe chronic pancreatitis. Arch Surg. 2000;135:1106–1111.

    Article  PubMed  CAS  Google Scholar 

  7. Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology. 2000;119:1324–1332.

    Article  PubMed  CAS  Google Scholar 

  8. Sutherland DE, Radosevich DM, Bellin MD, et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis. J Am Coll Surg. 2012;214:409–424.

    Article  PubMed  Google Scholar 

  9. Sutherland DE, Gruessner RW, Dunn DL, et al. Lessons learned from more than 1,000 pancreas transplants at a single institution. Ann Surg. 2001;233:463–501.

    Article  PubMed  CAS  Google Scholar 

  10. Ahmad SA, Lowy AM, Wray CJ, et al. Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. J Am Coll Surg. 2005;201:680–687.

    Article  PubMed  Google Scholar 

  11. Kobayashi T, Manivel JC, Carlson AM, et al. Correlation of histopathology, islet yield, and islet graft function after islet autotransplantation in chronic pancreatitis. Pancreas. 2011;40:193–199.

    Article  PubMed  Google Scholar 

  12. Tessier G, Bories E, Arvanitakis M, et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc. 2007;65:233–241.

    Article  PubMed  Google Scholar 

  13. Kalmin B, Hoffman B, Hawes R, Romagnuolo J. Conventional versus Rosemont endoscopic ultrasound criteria for chronic pancreatitis: comparing interobserver reliability and intertest agreement. Can J Gastroenterol. 2011;25:261–264.

    PubMed  Google Scholar 

  14. Manfredi R, Frulloni L, Mantovani W, et al. Autoimmune pancreatitis: pancreatic and extrapancreatic MR imaging-MR cholangiopancreatography findings at diagnosis, after steroid therapy, and at recurrence. Radiology. 2011;260:428–436.

    Article  PubMed  Google Scholar 

  15. Desai CS, Stephenson DA, Khan KM, et al. Novel technique of total pancreatectomy before autologous islet transplants in chronic pancreatitis patients. J Am Coll Surg. 2011;213:29–34.

    Article  Google Scholar 

  16. Balamurugan AN, Loganathan G, Bellin MD, et al. A new enzyme mixture to increase the yield and transplant rate of autologous and allogeneic human islet products. Transplantation. 2012;93:693–702.

    Article  PubMed  CAS  Google Scholar 

  17. Scheringa M, Van der Burg MPM, Basir I, Bouwman E. Assessment of isolated islet equivalents. Transpl Proc. 1997;29:1971–1973.

    Article  Google Scholar 

  18. Zhang XM, Shi H, Parker L, Dohke M, Holland GA, Mitchell DG. Suspected early or mild chronic pancreatitis: enhancement patterns on gadolinium chelate dynamic MRI. Magnetic resonance imaging. J Magn Reson Imaging. 2003;17:86–94.

    Article  PubMed  CAS  Google Scholar 

  19. Klöppel G, Detlefsen S, Feyerabend B. Fibrosis of the pancreas: the initial tissue damage and the resulting pattern. Virchows Arch. 2004;445:1–8.

    Article  PubMed  Google Scholar 

  20. Shimizu M, Hirokawa M, Manabe T. Histological assessment of chronic pancreatitis at necropsy. J Clin Pathol. 1996;49:913–925.

    Article  PubMed  CAS  Google Scholar 

  21. Klöppel G, Maillet B. Pathology of acute and chronic pancreatitis. Pancreas. 1993;8:659–670.

    Article  PubMed  Google Scholar 

  22. Robertson GS, Dennison AR, Johnson PR, London NJ. A review of pancreatic islet autotransplantation. Hepatogastroenterology. 1998;45:226–235.

    PubMed  CAS  Google Scholar 

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Conflict of interest

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Author notes

  1. Khalid M. Khan & Chirag S. Desai

    Present address: Transplant Institute MedStar Georgetown University Hospital, 3800 Reservoir Rd, Main 2, Washington, DC, USA

Authors and Affiliations

  1. Departments of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, PO Box 245066, Tucson, AZ, 85724, USA

    Khalid M. Khan, Chirag S. Desai, Brianna M. Grigsby, Tun Jie, Rainer W. G. Gruessner & Horacio Rodriguez-Rilo

  2. Departments of Radiology, University of Arizona, Tucson, AZ, USA

    Bobby Kalb

  3. Departments of Pathology, University of Arizona, Tucson, AZ, USA

    Charmi Patel

Authors
  1. Khalid M. Khan
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  2. Chirag S. Desai
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  3. Bobby Kalb
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  4. Charmi Patel
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  5. Brianna M. Grigsby
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  6. Tun Jie
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  7. Rainer W. G. Gruessner
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  8. Horacio Rodriguez-Rilo
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Corresponding author

Correspondence to Khalid M. Khan.

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Khan, K.M., Desai, C.S., Kalb, B. et al. MRI Prediction of Islet Yield for Autologous Transplantation After Total Pancreatectomy for Chronic Pancreatitis. Dig Dis Sci 58, 1116–1124 (2013). https://doi.org/10.1007/s10620-012-2448-1

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  • DOI: https://doi.org/10.1007/s10620-012-2448-1

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