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



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.


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.


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.


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.


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



Hemoglobin A1c


Endoscopic retrograde cholangiopancreatography


Islet equivalent units


Interquartile range


Total pancreatectomy with islet autotransplantation



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.


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)


  1. 1.
    Okano K, Hirao T, Unno M, Fujii T, Yoshitomi H, Suzuki S, Satoi S, Takahashi S, Kainuma O, Suzuki Y. Postoperative infectious complications after pancreatic resection. Br J Surg. 2015;102:1551–60.CrossRefGoogle Scholar
  2. 2.
    Fisher AV, Sutton JM, Wilson GC, Hanseman DJ, Abbott DE, Smith MT, Schmulewitz N, Choe KA, Wang J, Sussman JJ, Ahmad SA. High readmission rates after surgery for chronic pancreatitis. Surgery.2014;156:787–94.CrossRefGoogle Scholar
  3. 3.
    Shahbazov R, Naziruddin B, Yadav K, Saracino G, Yoshimatsu G, Kanak MA, Beecherl E, Kim PT, Levy MF. Risk factors for early readmission after total pancreatectomy and islet auto transplantation. HPB (Oxford). 2018;20:166–174.CrossRefGoogle Scholar
  4. 4.
    Berger MG, Majumder K, Hodges JS, Bellin MD, Schwarzenberg SJ, Gupta S, Dunn TB, Beilman GJ, Pruett TL, Freeman ML, Wilhelm JJ, Sutherland DE, Chinnakotla S. Microbial contamination of transplant solutions during pancreatic islet autotransplants is not associated with clinical infection in a pediatric population. Pancreatology. 2016;16:555–62.CrossRefGoogle Scholar
  5. 5.
    Witkowski P, Savari O, Matthews JB. Islet autotransplantation and total pancreatectomy. Adv Surg 2014;48:223–33.CrossRefGoogle Scholar
  6. 6.
    Savari O, Golab K, Wang LJ, Schenck L, Grose R,Tibudan M, et al. Preservation of beta cell function after pancreatic islet autotransplantation: University of Chicago experience. Am Surg 2015;81:421–7.Google Scholar
  7. 7.
    Vantyghem MC, Raverdy V, Balavoine AS et al. Continuous glucose monitoring after islet transplantation in type 1 diabetes: an excellent graft function (β-score greater than 7) Is required to abrogate hyperglycemia, whereas a minimal function is necessary to suppress severe hypoglycemia (β-score greater than 3). J Clin Endocrinol Metab. 2012;97:E2078–83.CrossRefGoogle Scholar
  8. 8.
    Schneider J, Schenk P, Obermeier A, Fremd J, Feihl S, Forkl S, Wantia N, Römmler F, Neu B, Bajbouj M, von Delius S, Schmid RM, Algül H, Weber A. Microbial colonization of pancreatic duct stents: a prospective analysis. Pancreas. 2015;44:786–90.CrossRefGoogle Scholar
  9. 9.
    Hill SK, Bhalla C, Thomson A. Risk of bacterial colonization of pancreatic stents used in endoscopic retrograde cholangiopancreatography. J Clin Gastroenterol. 2012;46:324–7.CrossRefGoogle Scholar
  10. 10.
    Kozarek R, Hovde O, Attia F, France R. Do pancreatic duct stents cause or prevent pancreatic sepsis?. Gastrointest Endosc. 2003;58:505–9.CrossRefGoogle Scholar
  11. 11.
    Carroll PB, Ricordi C, Fontes P, Rilo HR, Phipps J, Tzakis AG, Fung JJ, Starzl TE. Microbiologic surveillance as part of human islet transplantation: results of the first 26 patients. Transplant Proc. 1992;24:2798–9.Google Scholar
  12. 12.
    Wray CJ, Ahmad SA, Lowy AM, D'Alessio DA, Gelrud A, Choe KA, Soldano DA, Matthews JB, Rodriguez-Rilo HL. Clinical significance of bacterial cultures from 28 autologous islet cell transplant solutions. Pancreatology. 2005;5:562–9.CrossRefGoogle Scholar
  13. 13.
    Johnson CN, Morgan KA, Owczarski SM, Wang H, Fried J, Adams DB. Autotransplantation of culture-positive islet product: is dirty always bad?. HPB (Oxford). 2014;16:665–9.CrossRefGoogle Scholar
  14. 14.
    Colling KP, Blondet JJ, Balamurugan AN, Wilhelm JJ, Dunn T, Pruett TL, Sutherland DE, Chinnakotla S, Bellin M, Beilman GJ. Positive sterility cultures of transplant solutions during pancreatic islet autotransplantation are associated infrequently with clinical infection. Surg Infect (Larchmt). 2015;16:115–23.CrossRefGoogle Scholar
  15. 15.
    Jolissaint JS, Langman LW, DeBolt CL, Tatum JA, Martin AN, Wang AY, Strand DS, Zaydfudim VM, Adams RB, Brayman KL. The impact of bacterial colonization on graft success after total pancreatectomy with autologous islet transplantation: considerations for early definitive surgical intervention. Clin Transplant. 2016;30:1473–1479.CrossRefGoogle Scholar
  16. 16.
    Meier RPH, Andrey DO, Sun P, Niclauss N, Bédat B, Demuylder-Mischler S, Borot S, Benhamou PY, Wojtusciszyn A, Buron F, Pernin N, Muller YD, Bosco D, van Delden C, Berney T. Pancreas preservation fluid microbial contamination is associated with poor islet isolation outcomes - a multi-centre cohort study. Transpl Int. 2018;31:917–929.CrossRefGoogle Scholar
  17. 17.
    Taylor GD, Kirkland T, Lakey J, Rajotte R, Warnock GL. Bacteremia due to transplantation of contaminated cryopreserved pancreatic islets. Cell Transplant. 1994;3:103–6.CrossRefGoogle Scholar
  18. 18.
    Lakey JR, Rajotte RV, Warnock GL. Microbial surveillance of human islet isolation, in vitro culture, and cryopreservation. Clin Invest Med. 1995;18:168–76.Google Scholar
  19. 19.
    Bucher P, Oberholzer J, Bosco D, Mathe Z, Toso C, Bühler LH, Berney T, Morel P. Microbial surveillance during human pancreatic islet isolation. Transpl Int. 2005;18:584–9.CrossRefGoogle Scholar
  20. 20.
    Kin T, Rosichuk S, Shapiro AM, Lakey JR. Detection of microbial contamination during human islet isolation. Cell Transplant. 2007;16:9–13.CrossRefGoogle Scholar
  21. 21.
    Gala-Lopez B, Kin T, O'Gorman D, Pepper AR, Senior P, Humar A, Shapiro AM. Microbial contamination of clinical islet transplant preparations is associated with very low risk of infection. Diabetes Technol Ther. 2013;15:323–7.CrossRefGoogle Scholar
  22. 22.
    Murray L, McGowan N, Fleming J, Bailey L. Use of the BacT/alert system for rapid detection of microbial contamination in a pilot study using pancreatic islet cell products. J Clin Microbiol. 2014;52:3769–71.CrossRefGoogle Scholar
  23. 23.
    Qi M, Omori K, Mullen Y, McFadden B, Valiente L, Juan J, Bilbao S, Tegtmeier BR, Dafoe D, Kandeel F, Al-Abdullah IH. Prophylactically Decontaminating Human Islet Product for Safe Clinical Application: Effective and Potent Method. Transplant Direct. 2016;2:e63.CrossRefGoogle Scholar
  24. 24.
    Afghani E, Sinha A, Singh VK. An overview of the diagnosis and management of nutrition in chronic pancreatitis. Nutr Clin Pract. 2014;29:295–311.CrossRefGoogle Scholar
  25. 25.
    Bresnahan KA, Tanumihardjo SA. Undernutrition, the acute phase response to infection, and its effects on micronutrient status indicators. Adv Nutr. 2014;5:702–11CrossRefGoogle Scholar
  26. 26.
    Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 2013;70:195–283.CrossRefGoogle Scholar

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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