Distant processing of pancreas islets for autotransplantation following total pancreatectomy

doi:10.1016/S0002-9610(99)00078-1

The American Journal of Surgery

Volume 177, Issue 5, May 1999, Pages 423-427

Presented at the 85th Annual Meeting of the North Pacific Surgical Association, Tacoma, Washington, November 13–14, 1998.

https://doi.org/10.1016/S0002-9610(99)00078-1 Get rights and content

Abstract

background: Small duct chronic pancreatitis is associated with intractable pain and failure to thrive, usually unresponsive to conventional management approaches. Total pancreatectomy is considered after failure of medical intervention. The major morbidity following total pancreatectomy is diabetes mellitus with its associated complications. This adverse outcome can be mitigated through autotransplantation of islets recovered from the pancreatectomy specimen. This approach has been limited historically owing to the absence of an on-site islet processing facility. We present the results from 5 pancreatectomized patients whose islets were prepared 1,500 miles away.

methods: Five patients (4 women, 1 man, average age 42 years) who failed medical therapy and were not candidates for longitudinal pancreaticojejunostomy underwent total/completion pancreatectomy (4 total, 1 completion) for intractable symptoms from idiopathic small duct chronic pancreatitis. The resected pancreata were preserved in ViaSpan solution and were transferred to an islet processing laboratory by commercial airliner and returned. The dispersed pancreatic islet tissue was infused into a portal vein tributary through an operatively placed catheter after systemic heparinization.

results: All 5 patients experienced complete relief from pancreatic pain; 2 had significant residual discomfort from underlying Crohn’s disease. Three of the 5 patients had minimal or no insulin requirement after autotransplantation (median follow-up of 23 months); 1 patient continued with glycemic control difficulties related to Crohn’s disease. One patient died 17 months following autotransplantation from an unrelated pneumonia.

conclusion: Total pancreatectomy with autologous islet transplantation can offer patients with idiopathic small duct chronic pancreatitis pain relief without the sequelae of diabetes mellitus and can be performed without an on-site islet processing facility. All patients undergoing total/completion pancreatectomy should be considered candidates for this procedure.

Section snippets

Study population

Between August 1994 and October 1997 5 patients with idiopathic small duct chronic pancreatitis without evidence of duct obstruction underwent total or completion pancreatectomy with pancreatic islet autotransplantation at the Oregon Health Sciences University Hospital. Table I describes the patient population outlining prior surgical interventions as well as the duration of intractable abdominal pain and associated narcotic dependency at the time of pancreatectomy and autotransplantation. All

Results

All 5 patients had successful pancreatectomies with islet autotransplants. The first patient (PO) had a postoperative recovery complicated by adult respiratory distress syndrome and hemolytic anemia, both of which resolved with supportive care. Although the large mass of material infused into the circulation at the time of islet autotransplant is suspected to be related to these complications, the relationship to the islet infusion is speculative. The subsequent 4 patients had uncomplicated

Comments

Islet autotransplantation after a pancreatectomy was first proposed by Mirkovitch and Campiche.18 In their experimental model, 20 out of 25 pancreatectomized dogs normalized their serum glucose following autotransplantation of unpurified pancreas infused into the spleen. Unlike allograft islets, the autograft was not subject to the same destructive host immune response. Furthermore, preservation issues were mitigated with local preparation of the autograft.

The first clinical application of

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The images acquired had good quality with no noise and artifacts that could jeopardize its analysis. On the 14th day, HTG displayed no thyroid uptake, and the TG had a clear uptake of the thyroid graft in the topography of the biceps femoris muscle. Presented data also showed that both equipment spatial resolution and alignment (4.375 mm) did not interfere with the physiological uptake of ^99mTc by the thyroid graft.
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Indeed, with the possibility of remote isolation this would be the preferred approach. Both scenarios have comparable results7,8; the option of remote isolation is described elsewhere in this article. Pancreatic islet isolation for human transplantation should be performed in a laboratory that is in compliance with Food and Drug Administration good manufacturing practice (GMP) regulations, including maintenance of sterility, rigorous process validation, adequate and thorough process documentation, and other steps to maintain quality assurance.
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Scientific PapersDistant processing of pancreas islets for autotransplantation following total pancreatectomy

Abstract

Section snippets

Study population

Results

Comments

Cryobiology

Am J Surg

Chronic pancreatitis: diagnosis and treatment

Postgrad Med J

Chronic pancreatitis

NEJM

Surgical treatment of chronic pancreatitis

J Gastrointest Surg

Gastrointestinal and pancreatic complications associated with severe pancreatitis

Arch Surg

Current management of chronic pancreatitis

Adv Surg

Outcome of surgery for chronic pancreatitis

Br J Surg

Long-term results of pylorus-preserving pancreatoduodenectomy for chronic pancreatitis