Human Islet Autotransplantation to Prevent Diabetes after Pancreas Resection

Abstract

In severe cases of chronic pancreatitis pain relief can often only be achieved by pancreas resection, however this may render the patient diabetic. In an effort to prevent diabetes some patients may be suitable for a simultaneous islet autotransplant. The last report from the International Islet Transplant Registry has reported 222 cases. This review discusses the current progress in human islet autotransplantation.

Islet autotransplantation to prevent or minimize diabetes after pancreatectomy

“…During resection, the blood supply to the pancreas should be preserved as long as possible to minimize detrimental effects of warm ischemia on the islets [7,37,38]. The pylorus and spleen are usually spared whenever possible, though the benefits can be questioned, particularly with regard to retaining the pylorus.…”

Alpha 1-antitrypsin reduces inflammation and enhances mouse pancreatic islet transplant survival

“…Moreover, the marked nonimmunologic loss of islets may render the recipient prone to β-cell exhaustion long term (4). A multicenter review of autologous islet transplant outcomes reveals 31% of the autografts lose function within 7 d and 50% of the grafts that function at 7 d lose function within a year (5). Until these potentially linked problems, early nonimmunologic islet cell death, and failure to obtain enduring graft function are resolved, whole-organ transplantation, an intrusive and complication-prone procedure, will remain the transplant of choice because a single whole organ provides islet cell mass, sufficient to control hyperglycemia short and long term.…”

Clinical islet transplantation

“…Numerous successes in islet autotransplantation for patients undergoing total pancreatectomy for benign disease were reported [20]. Unfortunately, during this time, allogeneic islet transplants were not routinely effective.…”