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Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience

  • Justyna E. Gołębiewska
  • Piotr J. Bachul
  • Natalie Fillman
  • Mark R. Kijek
  • Lindsay Basto
  • Monica Para
  • Laurencia Perea
  • Karolina Gołąb
  • Ling-jia Wang
  • Martin Tibudan
  • Alicja Dębska-Ślizień
  • Jeffrey B. Matthews
  • John Fung
  • Piotr WitkowskiEmail author
Original Article
  • 23 Downloads

Abstract

Introduction

We assessed whether positive microbiological cultures from the islet preparation had any effect on the risk of infectious complications (IC) after total pancreatectomy with islet autotransplantation (TPIAT) in our center.

Methods

We analyzed preservation fluid and final islet product surveillance cultures with reference to clinical data of patients undergoing TPIAT. All patients received routine prophylactic broad-spectrum antibiotics.

Results

The study involved 10 men and 18 women with a median age of 39 years. Over 30% of surveillance cultures during pancreas processing grew bacterial strains with predominantly polymicrobial contaminations (13 of 22 (59%)). At least one positive culture was identified in almost half of the patients (46%) undergoing TPIAT and a third had both surveillance cultures positive. Infectious complications affected 50% of patients. After excluding cases of PICC line-associated bacteremia/fungemia present on admission, incidence of IC was higher in cases of positive final islet product culture than in those with negative result (57% vs. 21%), which also corresponded with the duration of chronic pancreatitis (p = 0.04). Surgical site infections were the most common IC, followed by fever of unknown origin. There was no concordance between pathogens isolated from the pancreas and those identified during the infection.

Conclusions

While IC was common among TPIAT patients, we found no concordance between pathogens isolated from the pancreas and those identified during infection. Contamination of the final islet product was of clinical importance and could represent a surrogate marker for higher susceptibility to infection.

Keywords

Total pancreatectomy with islet autotransplantation Infectious complications Surveillance cultures Autologous islet transplantation 

Abbreviations

HbA1c

Hemoglobin A1c

ERCP

Endoscopic retrograde cholangiopancreatography

IEQ

Islet equivalent units

IQR

Interquartile range

TPIAT

Total pancreatectomy with islet autotransplantation

Notes

Acknowledgments

We would like to thank the European Society for Organ Transplantation, which supported the training for Justyna Gołębiewska with ESOT Study Scholarship 2017. Martin Tibudan was supported by the University of Chicago Diabetes Research and Training Center, US Public Health Service Grant P30DK020595.

Author Contributions

Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content as per the guidelines of the International Committee of Medical Journal Editors.

Funding

Justyna Gołębiewska received the ESOT Study Scholarship from the European Society for Organ Transplantation, Martin Tibudan was partially supported by the University of Chicago Diabetes Research and Training Center, US Public Health Service Grant P30DK020595.

Compliance with Ethical Standards

The study was approved by the University of Chicago Institutional Review Board. All participants provided written informed consent.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4118_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 25 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Justyna E. Gołębiewska
    • 1
    • 2
  • Piotr J. Bachul
    • 1
    • 3
  • Natalie Fillman
    • 1
  • Mark R. Kijek
    • 1
  • Lindsay Basto
    • 1
  • Monica Para
    • 1
  • Laurencia Perea
    • 1
  • Karolina Gołąb
    • 1
  • Ling-jia Wang
    • 1
  • Martin Tibudan
    • 1
  • Alicja Dębska-Ślizień
    • 2
  • Jeffrey B. Matthews
    • 1
  • John Fung
    • 1
  • Piotr Witkowski
    • 1
    Email author
  1. 1.Department of Surgery, University of Chicago Medical CenterTransplantation InstituteChicagoUSA
  2. 2.Department of Nephrology, Transplantology and Internal MedicineMedical University of GdańskGdańskPoland
  3. 3.Department of AnatomyJagiellonian University Medical CollegeKrakowPoland

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