Prior Surgery Determines Islet Yield and Insulin Requirement in Patients With Chronic Pancreatitis

Abstract

Background Total pancreatectomy with islet autotransplantation (TP-IAT) is safe and effective in the management of intractable pain associated with chronic pancreatitis (CP). Prevention of pancreatogenic diabetes after TP-IAT is related to islet yield from the diseased pancreas. The purpose of this study is to compare islet yield and insulin requirement in the 76 patients who underwent different surgical procedures prior to TP-IAT at the Medical University of South Carolina between the years 2009 to 2011. Methods Patients were grouped into four categories based on the operation they had before TP-IAT: transduodenal sphincteroplasty or no prior surgery (TDS/NPS, n=50), Whipple or Beger procedure (WB, n=14), distal pancreatectomy (DP, n=8) or lateral pancreaticojejunostomy (LPJ, n=4). Islets were harvested from pancreases of those patients at our cGMP facility. Total unpurified islets were transplanted into patients via portal vein infusion. Pancreatic fibrosis, islet yield, cell viability and insulin requirement were measured. Results The pancreases of TDS/NPS and WB patients were less fibrotic, and had higher islet yield compared to those who had DP or LPJ. Higher islet yield also correlated with a greater diabetes free rate and a lesser insulin requirement at the following intervals: pre-operative, post-operative and 6 months after TP-IAT. Conclusions Prior surgery is strongly correlated with the extent of pancreatic fibrosis, islet yield and insulin requirements in CP patients undergoing TP-IAT. The history of prior pancreatic resection and drainage procedures may be used to predict post-operative islet function and help to determine the optimal timing for TP-IAT in CP patients.

Autotransplantation of culture-positive islet product: is dirty always bad?

“…Total pancreatectomy has received renewed interest in centres worldwide as a method of alleviating pain and improving quality of life in patients with CP in whom other options (endoscopic or lesser surgical interventions) have failed . As prolonged CP can lead to the destruction of islets for autotransplantation with risk for beta cell apoptosis, early intervention with TPIAT has been considered for better islet yields . Prior instrumentation potentially leads to bacterial contamination of the pancreas.…”

α-1 Antitrypsin Enhances Islet Engraftment by Suppression of Instant Blood-Mediated Inflammatory Reaction

“…Islet autotransplantation is used to avoid pancreatogenic diabetes in patients who undergo total pancreatectomy for chronic pancreatitis intractable to medical management (2). In both situations, islet engraftment after transplantation is compromised, and β-cell death is problematic.…”

Islet Harvest in Carbon Monoxide-Saturated Medium for Chronic Pancreatitis Patients Undergoing Islet Autotransplantation

“…Total pancreatectomy, islet isolation, and transplantation were performed as described previously 31 . Total islet number, islet viability, islet size index, endotoxin, and mycoplasma levels in the final islet product were measured after islet isolation.…”