Introduction: Infectious complications (IC) after pancreatic surgery occur in about 30% of patients. Although IC have not been extensively studied in patients submitted to total pancreatectomy with islet autotransplantation (TPIAT), it has been shown that microbiological contamination of the final islet preparation has no effect on the risk of developing infection. The aim of the study was to evaluate the prevalence, etiology and outcomes of all IC early after TPIAT with reference to the preservation fluid and islet preparation cultures.
Methods: We performed a retrospective cohort study reviewing medical records of patients submitted to TPIAT at the University of Chicago Medicine between January 2014 and October 2017. We analyzed preservation fluid and islet cultures with reference to clinical data. All patients received broad-spectrum antibiotic prophylaxis during the surgery.
Results: We studied data from 23 patients after TPIAT due to chronic pancreatitis and intractable pain (14 women and 9 men), with a mean age of 36 ± 14years. Most common IC were wound infections (22%), followed by PICC line associated bacteremia/fungemia (13%) and catheter associated urinary tract infections (9%).  Seven preservation fluids (30%) and 8 islet preparations (35%) showed positive microbial growth with a majority due to Gram-positive or Gram-negative intestinal flora and common polymicrobial contaminations (10 of 15 [66.6%]). Five patients (22%) had both positive preservation fluid and islet cell culture from the final islet preparation solution. Of those, 3 individuals developed complications- 1) fever without a clear source that required intravenous antibiotics, 2) pneumonia and 3) sepsis, wound infection and dehiscence, together with small and large bowel perforation. Two patients had positive preservation fluid cultures alone and only one of them developed a wound infection. Two out of 3 patients with positive islets cultures alone had IC, one developed a fever of unknown source and later a wound infection, while another one catheter associated urinary tract infection. None of the infections concurred with the positive preservation fluid or islet product cultures.  In 17 patients with both sterile preservation fluid and final islet product, three had a PICC line related bacteremia/fungemia and two developed wound infections. Four out of 5 patients with early wound infections developed hernias in the late postoperative course. There were also 3 cases of hernia without prior wound infection.
Conclusions: Infectious complications are a common problem in patients undergoing TPIAT and wound infections represent a consistent proportion and a risk factor for subsequent hernia development. Positive islet cultures may result from colonization and may be a marker of increased susceptibility to symptomatic infections, while positive preservation fluid culture alone seems to result from contamination during surgery and does not affect the outcome.