Strategies in Preventing Diabetes after Pancreatectomy Using Islet Auto- and Allo-Transplantation

Abstract

Over the years, pancreatectomy has been the primary treatment for chronic pancreatitis. Since the 1970s, total pancreatectomy has been shown to be effective at relieving pain that was experienced due to chronic pancreatitis. However, total pancreatectomy alone has the significant side effect of post-surgical diabetes. To treat post-pancreatectomy diabetes, total pancreatectomy was combined with Islet Autotransplantation (TP-IAT), which resulted in a much lower mortality rate compared to total pancreatectomy alone. Such operations require an expertise in islet isolation techniques, and thus this procedure is not widely performed.Since 2000, TP-IAT success has continued to increase. Improvement in islet isolation yield, better transplant techniques, and changes to post-operative care, have improved the islet engraftment and long-term survival rate. The Edmonton protocol, introduced in 2000, offers the option of islet allograft to complement total pancreatectomy. This protocol uses improved immunosuppressive regimens to improve islet allograft tolerance and accomplished higher rate of insulin independence. This advance led to improved clinical outcome after TP-IAT, including islet graft success after transplantation, reduction in narcotic use, pain, and improvement in quality of life.In this paper, we evaluated the history and advances of clinical islet transplant post-pancreatectomy. We also evaluated alternative transplant sites that are currently explored for islet graft, which are expected to offer improved islet engraftment and survival, and improved islet graft function.