Total Pancreatectomy With Islet Cell Auto-Transplantation: Update and Outcomes From Major Centers

Abstract

Chronic pancreatitis is the result of irreversible damage to pancreatic acinar cells, and can result in debilitating chronic pain for patients. Treatment centers on pain relief, often with chronic narcotic use. Surgical therapy consists of both resection procedures to remove affected pancreatic parenchyma and drainage procedures to facilitate drainage of the main pancreatic duct. Total pancreatectomy historically was utilized in extreme cases due to the brittle glucose control that followed from the total loss of islet cells. Total pancreatectomy with islet cell auto-transplantation (TP-AIT) is gaining in popularity due to the maintenance of beta cell mass and the ability of patients to potentially be insulin independent post-operatively. TP-AIT is very helpful in the treatment of pain for patients with chronic pancreatitis. The overall majority of patients have an improvement in pain and quality-of-life scores. AIT also allows the majority of patients to have minimal insulin requirements post-operatively. With proper patient selection, these outcomes can be achieved.

Mesenchymal Stem Cells from Chronic Pancreatitis Patients Show Comparable Potency Compared to Cells from Healthy Donors

“…Unlike insulin‐dependent type 1 diabetes, glycemic control after total pancreactectomy is notoriously difficult with standard pharmacologic insulin therapy due to the absence of glucagon‐dependent counter‐regulation from islet α cells. For these patients, TP‐IAT has the distinct advantage of allowing patients the ability to avoid this surgically induced “brittle diabetes.” However, only approximately 30% of patients at 3 years after TP surgery were insulin independent . Therefore, therapies that can improve the outcomes of autologous islet transplantation could substantially benefit patients undergoing TP‐IAT.…”

“…For these patients, TP-IAT has the distinct advantage of allowing patients the ability to avoid this surgically induced "brittle diabetes." However, only approximately 30% of patients at 3 years after TP surgery were insulin independent [50]. Therefore, therapies that can improve the outcomes of autologous islet transplantation could substantially benefit patients undergoing TP-IAT.…”

Transplantation technologies for treatment of carbohydrate metabolism disorders

“…В основе указанного метода лечения заложено тотальное удаление поджелудочной железы как источника стойкого болевого синдрома с последующей аутотрансплантацией островков, чаще всего в воротную вену [56]. Количество подобных оперативных вмешательств в последнее время имеет стойкую тенденцию к увеличению [57][58][59]. Абсолютное большинство центров демонстрируют нулевую летальность после операции, при общем анализе она не превышает 1% [60,61].…”

Autoimmunity in Autologous Islet Transplantation

“…Total pancreatectomy (TP) is considered the therapy of last resort in patients with debilitating CP, often leading to reduced analgesic use, decreased frequency of hospital admissions for pain, and improvement in quality of life [2]. This surgical procedure can be performed with transplantation of islets of Langerhans (autologous islet transplantation, AIT) recovered from the resected pancreas, and is intended to prevent or attenuate surgical diabetes in select patients based on pre-surgical metabolic assessments [3][4][5]. AIT appears not to be significantly affected by the stress of cellular rejection encountered in allotransplantation for type 1 diabetes mellitus (DM) [6].…”