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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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.

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Abbreviations

HbA1c:

Hemoglobin A1c

ERCP:

Endoscopic retrograde cholangiopancreatography

IEQ:

Islet equivalent units

IQR:

Interquartile range

TPIAT:

Total pancreatectomy with islet autotransplantation

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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.

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.

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Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA

    Justyna E. Gołębiewska, Piotr J. Bachul, Natalie Fillman, Mark R. Kijek, Lindsay Basto, Monica Para, Laurencia Perea, Karolina Gołąb, Ling-jia Wang, Martin Tibudan, Jeffrey B. Matthews, John Fung & Piotr Witkowski

  2. Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland

    Justyna E. Gołębiewska & Alicja Dębska-Ślizień

  3. Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland

    Piotr J. Bachul

Authors
  1. Justyna E. Gołębiewska
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  2. Piotr J. Bachul
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  3. Natalie Fillman
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  4. Mark R. Kijek
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  5. Lindsay Basto
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  6. Monica Para
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  7. Laurencia Perea
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  8. Karolina Gołąb
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  9. Ling-jia Wang
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  10. Martin Tibudan
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  11. Alicja Dębska-Ślizień
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  12. Jeffrey B. Matthews
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  13. John Fung
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  14. Piotr Witkowski
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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.

Corresponding author

Correspondence to Piotr Witkowski.

Ethics declarations

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

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The authors declare that they have no conflict of interest.

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Gołębiewska, J.E., Bachul, P.J., Fillman, N. et al. Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience. J Gastrointest Surg 23, 2201–2210 (2019). https://doi.org/10.1007/s11605-019-04118-y

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  • DOI: https://doi.org/10.1007/s11605-019-04118-y

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