Islet Autotransplantation After Distal Pancreatectomy for Pancreatic Trauma

Garraway, Naisan; Dean, Sean; Buczkowski, Andrzej K.; Brown, David R.; Scudamore, Charles H.; Meloche, Mark; Warnock, Garth L.; Simons, Richard K.

doi:10.1097/ta.0b013e31815ede90

Cited by 19 publications

(5 citation statements)

References 18 publications

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“…11,[13][14][15] More recently, the indication of IAT has been extended to the loss of pancreatic parenchyma for the resection of benign tumors of the mid-segment of the pancreas [16][17][18] or after total pancreatectomy for severe abdominal trauma. 19,20 In this study, we report our experience with IAT for the treatment of patients undergoing pancreatic surgery for both nonmalignant and malignant diseases, including subjects undergoing completion pancreatectomy because of anastomosis leakage after pancreaticoduodenectomy (PD) and subjects with pancreatic anastomosis deemed at high risk of failure during PD.…”

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confidence: 99%

Extending Indications for Islet Autotransplantation in Pancreatic Surgery

et al. 2013

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confidence: 99%

Extending Indications for Islet Autotransplantation in Pancreatic Surgery

et al. 2013

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“…The first case received 88,000; she was insulin free at 20 months follow-up. The second case received distal pancreatectomy with splenectomy with infusion of 325,000 pancreatic islets into the portal vein on postoperative day 4; a few hours later, the patient's blood sugars normalized and he was taken off insulin (7). It should be noted that total pancreatectomy was not carried out in these cases and it is not possible to ascertain the function of implanted islets (as opposed to function of the native pancreas).…”

Section: Discussionmentioning

confidence: 99%

Remote Processing of Pancreas can Restore Normal Glucose Homeostasis in Autologous Islet Transplantation after Traumatic Whipple Pancreatectomy: Technical Considerations

et al. 2012

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An emergency autologous islet transplant after a traumatic Whipple operation and subsequent total pancreatectomy was performed for a 21-year-old patient who was wounded with multiple abdominal gunshot wounds. After Whipple pancreatectomy, the remnant pancreas (63.5 g), along with other damaged organs, was removed by the surgeons at Walter Reed Army Medical Center (WRAMC) and shipped to Diabetes Research Institute (DRI) for islet isolation. The pancreas was preserved in UW solution for 9.25 h prior to islet isolation. Upon arrival, the organ was visually inspected; the pancreatic head was missing, the rest of the pancreas was damaged and full of blood; the tail looked normal. A 16-gauge catheter was inserted into the main duct and directed towards tail of the pancreas after the dissection of main duct in the midbody of the pancreas. The pancreas was distended with collagenase solution (Roche MTF) through the catheter. During 10 min of intraductal delivery of enzyme, the gland was distended uniformly. No leakage of the solution was observed. The pancreas was transferred to a Ricordi chamber for automated mechanical and enzymatic digestion. Islets were purified using a COBE 2991 cell processor. Islet equivalents (IEQ; 221,250) of 40% purity and 90% viability were recovered during the isolation, which were shipped back to WRAMC and infused by intraportal injection into the patient. Immediate islet function was demonstrated by the rapid elevation of serum C peptide followed by insulin independence with near normal oral glucose tolerance test (OGTT) 1 and 2 months later. It is possible to restore near normal glucose tolerance with autologous islet transplantation after total pancreatectomy even with suboptimal number of islets while confirming that islets processed at a remote site are suitable for transplantation.

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“…In addition, AIT has been performed after major pancreatectomy for benign neoplasms 15,21,22 and for trauma 23,24 . These conditions are considered to be qualifying factors for AIT.…”

Section: Indications For Aitmentioning

confidence: 99%

“…After unequivocal histopathologic diagnosis of the benign nature of the tumor, AIT was performed. There is no definitive procedure for determining the eligibility of trauma cases for AIT because only case reports have been published so far 23,24 …”

Section: Indications For Aitmentioning

confidence: 99%

Autologous islet cell transplantation to prevent surgical diabetes

Matsumoto

2011

Journal of Diabetes

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Autologous islet transplantation (AIT) is performed to prevent surgical diabetes after total or semi-total pancreatectomy for the treatment of chronic pancreatitis with severe abdominal pain. In addition, AIT is used in cases of benign pancreatic tumors and pancreatic trauma. It has been shown that AIT results in better outcomes in terms of glycemic control compared with allogeneic islet transplantation. The reasons for the favorable outcomes of AIT are thought to be: (i) patients have no autoimmune diseases; (ii) the transplanted islets do not suffer allogeneic rejection; (iii) diabetogenic antirejection drugs are not required; (iv) pancreata do not undergo a cytokine storm as a result of periods of brain death; (v) the period of cold preservation of retrieved pancreata is short; (vi) the isolated islets are immediately transplanted without culture; and (vii) pancreata with pancreatitis may contain more progenitor cells. Further research into AIT would help improve the results of allogeneic islet transplantation. Conversely, the technical difficulties associated with islet isolation appear to be the largest hurdle for AIT; therefore, remote center islet isolation may prove to be key in the promotion of this treatment.

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Islet Autotransplantation After Distal Pancreatectomy for Pancreatic Trauma

Cited by 19 publications

References 18 publications

Extending Indications for Islet Autotransplantation in Pancreatic Surgery

Extending Indications for Islet Autotransplantation in Pancreatic Surgery

Remote Processing of Pancreas can Restore Normal Glucose Homeostasis in Autologous Islet Transplantation after Traumatic Whipple Pancreatectomy: Technical Considerations

Autologous islet cell transplantation to prevent surgical diabetes

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