Islet auto transplantation following total pancreatectomy: a long-term assessment of graft function

Pancreas. 2008 Oct;37(3):282-7. doi: 10.1097/mpa.0b013e31816fd7b6.

Abstract

Total pancreatectomy is considered the final resort in the treatment of chronic pancreatitis; however, here we show that simultaneous islet autotransplantation can abrogate the onset of diabetes.

Methods: : In Leicester, 46 patients have now undergone total pancreatectomy with immediate islet auto transplant, and they have received a median of 2246 islet equivalent (IEQ)/kg body weight (range, 405-20,385 IEQ/kg body weight).

Results: : Twelve patients have shown periods of insulin independence, for a median of 16.5 months (range, 2-63 months), and 5 remain insulin independent. Over the 10 years of follow-up, there has been a notable increase in insulin requirement per kilogram per day, and percentage of glycosylated hemoglobin levels have increased significantly (r = 0.66, P = 0.01). However, 100% of patients tested were C-peptide positive at their most recent assessment, and high fasting and stimulated C-peptide values recorded at 10 years after transplantation, 1.44 (range, 1.09-1.8 ng/mL) and 2.86 ng/mL (range, 1.19-4.53 ng/mL), respectively, suggest significant graft function in the long term. In addition, median serum creatinine has increased very little after the operation (71 nmol/L [range, 49-125 nmol/L] atpreoperation vs 76.5 nmol/L [range 72-81 nmol/L] at year 10), suggesting no diabetic nephropathy.

Conclusions: : Although there is a notable decline in islet function after islet auto transplant, there is still evidence of significant long-term insulin secretion and possible protection against diabetic complications.

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • C-Peptide / blood
  • Diabetes Complications / etiology
  • Diabetes Complications / metabolism
  • Diabetes Complications / mortality
  • Diabetes Complications / prevention & control*
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / metabolism
  • Graft Survival*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / metabolism
  • Insulin / therapeutic use
  • Islets of Langerhans / metabolism
  • Islets of Langerhans / surgery*
  • Islets of Langerhans Transplantation*
  • Male
  • Pancreatectomy* / adverse effects
  • Pancreaticoduodenectomy* / adverse effects
  • Pancreatitis, Chronic / surgery*
  • Time Factors
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Blood Glucose
  • C-Peptide
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human