Pharmacological management of patients undergoing total pancreatectomy with auto-islet transplantation

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2022-06, Vol.22 (5), p.656-664
• Main Authors: Szempruch, Kristen R., Walter, Krysta, Ebert, Natassha, Bridgens, Kathryn, Desai, Chirag S.
• Format: Article
• Language: English
• Subjects: Anti-inflammatory agents; Anticoagulation; Aspirin; Autografts; Blood platelets; Diabetes; Digestive enzymes; Disease management; Enzymes; Gastrointestinal; Glucose management; Inflammation; Islet cells; Pancreas; Pancreas transplantation; Pancreatectomy; Pancreatic islet transplantation; Pancreatitis; Patients; Pharmacological; Population; Prophylaxis; Thrombosis; TNF inhibitors; Total pancreatectomy with islet cell autotransplantation; Transplants & implants; Tumor necrosis factor-TNF; Veins & arteries
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2022.04.009

Chronic pancreatitis results in permanent parenchymal destruction of the pancreas gland leading to anatomical and physiological consequences for patients. Surgical management varies, and some patients require total pancreatectomy with autologous islet cell transplantation (TPIAT). Patients undergoing TPIAT require complex and diligent management after surgery. This encompasses the management of glucose control (endocrine function of the pancreas) and supplementing loss of exocrine function of the pancreas with digestive enzymes. Other areas of management include optimizing pain relief while reducing narcotic usage, providing antimicrobial prophylaxis, and reducing loss of islet cells by improving its integrity through anticoagulation and use of anti-inflammatory agents. Each aspect of care is unique to this population. However, comprehensive reviews on its pharmacological management are scarce. This review will discuss the available literature to date surrounding all aspects of pharmacological management of patients undergoing TPIAT.