Pancreatic islet autotransplantation with total pancreatectomy for chronic pancreatitis

Abstract

Pain relief and improvement in quality of life are the main targets for treatment of chronic pancreatitis. The use of total pancreatectomy for chronic pancreatitis is a radical and in some ways ideal strategy. However, total pancreatectomy is associated with severe diabetic control problems. Total pancreatectomy with islet autotransplantation can relieve severe pain and prevent post-surgical diabetes. In islet autotransplantation, patients with chronic pancreatitis receive their own islet cells and therefore do not require immunosuppression. In the future, total pancreatectomy with islet autotransplantation may be considered a treatment option for chronic pancreatitis patients.

Pancreatic islet autotransplantation for nonmalignant and malignant indications

“…Severe recurrent abdominal pain results from elevated pressure in the pancreatic ducts or pancreatic parenchyma caused by obstruction of the pancreatic ducts . Studies have also shown that nerve injury and neuroimmune interactions between neuronal processes and chronic inflammation can lead to severe pain . Surgical resection procedures such as pancreaticoduodenectomy, distal pancreatectomy (DP), and TP are performed to treat the pain associated with CP .…”

“…Patients with CP undergoing TP are candidates for islet transplantation . At the University of Minnesota, candidates for TP‐IAT must have abdominal pain for more than 6 months with impaired quality of life (e.g., inability to work, inability to participate in ordinary activities, repeated hospitalizations, or constant need for narcotics, each coupled with failure to respond to maximal medical treatment or endoscopic pancreatic duct drainage procedures).…”

“…CP is a benign inflammatory disease characterized by fibrosis and destruction of the entire pancreas leading to irreversible and severe damage of both exocrine and endocrine functions. [17][18][19][20][21][22] The symptoms of CP include upper abdominal pain, unintentional weight loss, and steatorrhea. Severe recurrent abdominal pain results from elevated pressure in the pancreatic ducts or pancreatic parenchyma caused by obstruction of the pancreatic ducts.…”

“…Patients with CP undergoing TP are candidates for islet transplantation. 17 At the University of Minnesota, candidates for TP-IAT must have abdominal pain for more than 6 months with impaired quality of life (e.g., inability to work, inability to participate in ordinary activities, repeated hospitalizations, or constant need for narcotics, each coupled with failure to respond to maximal medical treatment or endoscopic pancreatic duct drainage procedures). There must also be objective findings of CP, including at least one of the following: pancreas calcifications on CT scan, abnormal endoscopic retrograde cholangiopancreatography, or at least six of nine criteria on endoscopic ultrasound; any two of the following: ductal or parenchymal abnormalities on secretin-stimulated magnetic resonance cholangiopancreatography, endoscopic ultrasound of pancreas with six of nine criteria positive, or abnormal pancreatic function tests with peak bicarbonate of less than 80 mmol/L; or histopathologic-confirmed diagnosis of CP from previous operations; or hereditary pancreatitis (PRSS1 gene mutation, SPINK1 gene mutation, CFTR gene mutations) with a compatible clinical history; or history of recurrent acute pancreatitis with more than episodes of pain associated with imaging diagnosis of acute pancreatitis and/or elevated serum amylase or lipase three times normal.…”

Total Pancreatectomy and Islet Auto-Transplantation for Chronic Painful Pancreatitis: An Overview

“…A total pancreatectomy (TP) completely removes the root cause of pancreatitis pain. The diseased gland is excised completely and, unlike with partial resections or surgical drainage procedures, there is no potential for pancreatic duct leakage [15]. Performed in isolation, without preservation of any beta-cell function, a TP would result in brittle surgically-induced diabetes with the added problem of exocrine pancreatic insufficiency.…”