Islet autotransplantation in focal intraductal papillary mucinous neoplasms: Evaluating feasibility, safety, and metabolic outcomes in pancreatic resection

Islet auto transplantation (IAT) is a potential therapeutic option for patients undergoing pancreatectomy to preserve endocrine function, but its role in patients with intraductal papillary mucinous neoplasms (IPMNs) remains controversial due to oncological concerns. This study evaluated the feasibility, safety, and metabolic outcomes of IAT in 7 patients with focal IPMNs who underwent pancreatectomy between 2008 and 2023, following the Milan protocol. Primary outcomes included the technical success of islet isolation and the absence of tumor dissemination. Secondary outcomes included insulin independence and metabolic control posttransplant. Islet isolation success was variable, with 4 patients meeting the criteria for transplantation. The average islet yield was 1097 islet equivalents per kilogram of body weight (range: 219-1833 islet equivalents/kg). No patient experienced complications related to islet infusion, and there was no evidence of tumor recurrence or metastasis during a mean follow-up of 7.9 years (range: 3.99-11.88 years). IAT recipients demonstrated preserved insulin secretion, whereas nontransplanted patients developed diabetes. These findings support the feasibility and safety of IAT in carefully selected patients with focal IPMNs, providing promising metabolic outcomes. The results open the possibility to initiate larger cohort studies and explore the potential to expand the population of patients who could benefit from this approach.