Implementing Best Practice Guidelines in Autologous Islet Transplantation through an International Survey

Background - Islet Autotransplantation (IAT) following pancreatectomy due to chronic pancreatitis (CP) serves as a mitigation strategy against postoperative diabetes. IAT has proven to be a promising technique with good functional outcome. Subsequently, it is anticipated that indications for and use of IAT will increase in the coming years. A recent proposal has advocated that the criteria should be expanded to include patients with high-risk pancreatic stump, extended parenchymal resections for benign diseases, and for the management of severe postoperative complications (i.e., pancreatic fistula). Currently, there appears to be significant variation in islets isolation techniques and transplantation strategies among expert centers, and consensus on standard of care policies are lacking. Aim - To evaluate current use and practice of IAT across international expert centers. The results will be analyzed to define the current indications for IAT procedure, the technical information about the pancreas processing, the location where the process of islet isolation takes place, when and how islet infusion procedure is carried out. Methods - A standard of care survey will be disseminated worldwide among IAT expert centers. Current indications for IAT, details regarding processing of the pancreas, islet purification and of islet infusion protocols will be assessed. Discussion - IAT is a promising procedure to prevent or alleviate new onset pancreatogenic diabetes mellitus and its complications. However, consensus regarding IAT procedure is currently lacking among expert centers. The results of this international survey will be examined with the aim of suggesting best best-practice guidelines for IAT.