Perioperative nursing care for a patient undergoing image-guided planned autologous islet transplantation after total pancreatectomy: A case report

RATIONALE: Total pancreatectomy (TP) often leads to insulin-deficient diabetes, including unstable "brittle diabetes." Autologous islet transplantation during or after TP can prevent or treat diabetes by reinfusing functional islets into the portal vein. This case report details the perioperative nursing strategies for a patient undergoing image-guided planned autologous islet transplantation following TP. PATIENT CONCERNS: A 64-year-old male with pancreatic cancer, type 2 diabetes, and hypertension underwent TP and initial autologous islet transplantation but required a second transplantation due to poor graft function. Preoperatively, he exhibited fluctuating blood glucose (8.9-14.5 mmol/L) and anxiety about surgical outcomes. DIAGNOSES: The patient was diagnosed with recurrent pancreatic cancer post-TP and chemotherapy, compounded by insulin-dependent diabetes and suboptimal islet function necessitating secondary transplantation. INTERVENTIONS: A multidisciplinary approach included meticulous preoperative islet quality control, intraoperative portal vein catheterization under ultrasound guidance, and dynamic monitoring of portal pressure. Postoperative care featured anticoagulation (heparin/low-molecular-weight heparin), glycemic management via insulin micropump, and thromboprophylaxis using intermittent pneumatic compression. Psychological support and preoperative education alleviated patient anxiety. OUTCOMES: Posttransplantation, blood glucose stabilized (3.9-7.7 mmol/L), enabling discontinuation of exogenous insulin. The patient was discharged on day 18 without complications such as thrombosis or hemorrhage. LESSONS: Multidisciplinary collaboration, tailored nursing interventions, and rigorous complication prevention ensured successful outcomes. This case highlights the critical role of structured perioperative care in achieving insulin independence after complex islet transplantation.