Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: the first 40 patients at the leicester general hospital.
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.
Clayton
Heather A
HA
Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.
Davies
Joanna E
JE
Pollard
Cris A
CA
White
Steve A
SA
Musto
Patrick P
PP
Dennison
Ashley R
AR
D000328:Adult; D000368:Aged; D002096:C-Peptide / Q000097:blood; D002452:Cell Count; D002908:Chronic Disease; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006769:Hospitals, General; D006801:Humans; D007515:Islets of Langerhans / Q000473:pathology; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010180:Pancreatectomy; D010195:Pancreatitis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous / Q000502:physiology*
D002096:C-Peptide; D006442:Glycated Hemoglobin