title: Distant processing of pancreas islets for autotransplantation following total pancreatectomy.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Oregon Health Sciences University and Portland Veterans Affairs Medical Center, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Rabkin
authors.forename: A J
authors.initials: AJ
authors.lastname: Olyaei
authors.forename: S L
authors.initials: SL
authors.lastname: Orloff
authors.forename: S M
authors.initials: SM
authors.lastname: Geisler
authors.forename: D C
authors.initials: DC
authors.lastname: Wahoff
authors.forename: B J
authors.initials: BJ
authors.lastname: Hering
authors.forename: D E
authors.initials: DE
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D018929:Cell Culture Techniques / Q000379:methods; D002470:Cell Survival; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010180:Pancreatectomy; D010195:Pancreatitis / Q000601:surgery*; D016896:Treatment Outcome