Autologous Islet Transplantation After Total Pancreatectomy in a Patient Recovered from SARS-CoV-2: A Case Report.

BACKGROUND SARS-CoV-2 infection or COVID-19 disease has been linked to the onset of diabetes and metabolic dysregulation because it has been suggested that viral entry proteins, specifically ACE2 and TMPRSS2, are expressed in the exocrine cells and ductal epithelium of the pancreas. Because of the unknown effect this can have on islet function, there can be doubt that patients with previous SARS-CoV-2 infections are good candidates for autologous islet transplantation after total pancreatectomy (TPAIT). CASE REPORT A patient with a history of chronic pancreatitis and previous non-surgical interventions was presented as a viable candidate for TPAIT at our institution. Approximately 1 month later, the patient contracted a SARS-CoV-2 infection, resulting in a mild case of COVID-19. The infection resolved without the need for hospitalization. At the time of this occurrence, COVID-19 was primarily considered a respiratory ailment, and little was known of the potential association between metabolic dysfunction and SARS-CoV-2. Islet isolation and surgery proceeded in a textbook manner with no surgical complications. The patient was weaned off exogenous insulin within 3 months after transplantation. CONCLUSIONS Favorable outcomes after surgery included pain reduction, islet function, and improved quality of life for the patient in the first 6 months after the procedure. These successful results demonstrate that SARS-CoV-2 infection did not prevent the patient from achieving good glucose regulation after auto-islet transplantation. This outcome suggests that, at least in this instance of mild infection, there were no long-lasting negative COVID-19-associated effects on the transplanted islets that might impact islet function.

Therapeutic Hypothermia and Targeted Temperature Management for Traumatic Arrest and Surgical Patients.

Therapeutic hypothermia (TH) and targeted temperature management (TTM) have been shown to improve outcomes in survivors of cardiac arrest, but prior research has excluded trauma and postoperative patients. We sought to determine whether TH/TTM is safe in trauma and surgical patients. A retrospective cohort study was conducted at a single level I trauma center reviewing adults presenting as a traumatic arrest or cardiac arrest in the postoperative period with a Glasgow Coma Scale <8 after return of circulation who were treated with either TH or TTM. Neurological recovery is considered favorable if a patient was discharged following commands. A total of 32 cardiac arrest patients were included in the study, 14 of whom were treated with TH and 18 with TTM protocols, with goal temperatures of 33°C and 36°C, respectively. Mean age of the cohort was 60 ± 13, with 26 (81%) men. There were 18 trauma patients and 14 postoperative patients. Complications included pneumonia (13%), sepsis (6%), bleeding requiring transfusion (22%), arrhythmias (6%), and seizures (9%), which are similar to prior published series. Overall survival to discharge was 41% (n = 13), and all survivors had favorable neurological recovery. Traumatic arrest and perioperative cardiac arrest patients previously excluded from TH/TTM studies appear to have an acceptable incidence of complications compared with standard TH/TTM patients.