Pediatric Autologous Islet Transplantation

Abstract

A total pancreatectomy and islet autotransplant (TPIAT) offers substantial pain relief and improved quality of life for children who are severely affected by chronic or recurrent acute pancreatitis and for whom the usual medical and endoscopic therapies have failed. The pancreas is entirely resected, and the pancreatic islets are isolated from the pancreas and infused back into the patient’s liver. Because this is an autologous transplant, no immunosuppression is required. Over several months, the islets engraft in the liver; the patient is then slowly weaned off insulin therapy. Slightly more than 40 % of patients become and remain insulin independent, yet even among patients who remain on insulin, most have some islet function, permitting easier diabetes control. The majority of patients experience pain relief, with significant improvements in health-related quality of life. A TPIAT should be considered for children who are significantly disabled by chronic pancreatitis.

EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

“…Organ preservation should be the goal, but total pancreatectomy with islet autotransplant (TPIAT) should be considered as well 131,132 . EUS drainage via endoscopic cystgastrostomy has become the standard of care for drainage of large and symptomatic pancreatic pseudocysts in children 115,133,134 .…”

Pancreatitis in Children

“…[6][7][8] Pancreatitis is a clinical diagnosis based on a combination of history, physical examination, laboratory testing, and imaging findings as listed in Table 1. 9 Physicians from centers that perform total pancreatectomy and islet autotransplantation (TPIAT) report a sizable number of children with CP, 10 confirming that the incidence and prevalence of pediatric CP should be substantial. However, 2 population studies that included children in their cohort found an incidence of CP in children of w0.5 per 100,000 persons per year, 11,12 which was only approximately one eighth the incidence reported in adults.…”

Paediatric pancreatic diseases

“…22 Patients may benefit from substantial pain relief and improved quality of life, but over half of patients require long-term insulin therapy. 23 Expert-based guidelines are available for more detailed information. 14,24,25…”

“…The role, indications and optimal timing of total pancreatectomy with islet cell auto‐transplantation are still evolving with increasing experience and improved outcomes 22. Patients may benefit from substantial pain relief and improved quality of life, but over half of patients require long‐term insulin therapy 23. Expert‐based guidelines are available for more detailed information 25…”