Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: the first 40 patients at the leicester general hospital

Transplantation. 2003 Jul 15;76(1):92-8. doi: 10.1097/01.TP.0000054618.03927.70.

Abstract

Background: Surgical resection of the pancreas is considered a final resort in the treatment of chronic pancreatitis. However, the opportunity to perform an islet autotransplant at the same time provides the potential to prevent the onset of diabetes.

Methods: Pancreatectomy together with islet autotransplantation has been offered in our center since 1994. A total of 40 patients have now undergone this procedure. The follow-up times range from 6 months to 7 years. The data presented here include the annual postoperative oral glucose tolerance test and glycosylated hemoglobin (HbA(1c)) results, together with insulin and opiate requirements.

Results: Nineteen male and 21 female patients (median age 44, range 21-65) have been transplanted. Pancreatitis was related to alcohol in 45% and was idiopathic in 40%. A median of 130108 (24332-1, 165538) islet equivalent (IEQ) were transplanted, which related to 2020 (320-23311) IEQ per kilogram of body weight. At 2 years posttransplant, 18 patients had a median HbA(1c) of 6.6% (5.2-19.3%), fasting C-peptide of 0.66 ng/mL (0.26-2.65 ng/mL), and required a median of 12 (0-45) units of insulin per day. At 6 years, these figures were 8% (6.1-11.1%), 1.68 ng/mL (0.9-2.78 ng/ml) and 43 U/day (6-86 U/day), respectively. The majority of patients no longer require opiate analgesia, 68% have been able to return to work, and one patient has had a baby.

Conclusions: Islet autotransplantation offers a valuable addition to surgical resection of the pancreas, as a treatment for chronic pancreatitis; and even in cases in which insulin independence is not achieved, the potential beneficial effects of C-peptide make the procedure worthwhile.

MeSH terms

  • Adult
  • Aged
  • C-Peptide / blood
  • Cell Count
  • Chronic Disease
  • England
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / analysis
  • Hospitals, General
  • Humans
  • Islets of Langerhans / pathology
  • Islets of Langerhans Transplantation / methods*
  • Male
  • Middle Aged
  • Organ Size
  • Pancreatectomy*
  • Pancreatitis / surgery*
  • Retrospective Studies
  • Time Factors
  • Transplantation, Autologous / physiology*

Substances

  • C-Peptide
  • Glycated Hemoglobin A