Total pancreatectomy and autologous islet cell transplantation as a means to treat severe chronic pancreatitis.
Autologous islet cell transplantation after near-total or total pancreatic resection can alleviate pain in patients with severe chronic pancreatitis and preserve endocrine function. From February 2000 to February 2003, a total of 22 patients, whose median age was 38 years, underwent pancreatectomy and autologous islet cell transplantation. Postoperative complications, metabolic studies, insulin usage, pain scores, and quality of life were recorded for all of these patients. The average number of islet cells harvested was 245,457 (range 20,850 to 607,466). Operative data revealed a mean estimated blood loss of 635 ml, an average operative time of 9 hours, and a mean length of hospital stay of 15 days. Sixty-eight percent of the patients had either a minor or major complication. Major complications included acute respiratory distress syndrome (n=2), intra-abdominal abscess (n=1), and pulmonary embolism (n=1). There were no deaths in our series. All patients demonstrated C-peptide and insulin production indicating graft function. Forty-one percent are insulin independent, and 27% required minimal amount of insulin or a sliding scale. All patients had preoperative pain and had been taking opioid analgesics; 82% no longer required analgesics postoperatively. Pancreatectomy with autologous islet cell transplantation can alleviate pain for patients with chronic pancreatitis and preserve endocrine function.
Rodriguez Rilo
Horacio L
HL
Pancreatic Disease Center, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0558, USA. Rilohl@uc.edu
Ahmad
Syed A
SA
D'Alessio
David
D
Iwanaga
Yasuhiro
Y
Kim
Joseph
J
Choe
Kyuran A
KA
Moulton
Jonathan S
JS
Martin
Jill
J
Pennington
Linda J
LJ
Soldano
Debbie A
DA
Biliter
Jamie
J
Martin
Steve P
SP
Ulrich
Charles D
CD
Somogyi
Lehel
L
Welge
Jeffrey
J
Matthews
Jeffrey B
JB
Lowy
Andrew M
AM
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement / Q000379:methods; D010180:Pancreatectomy / Q000379:methods*; D010195:Pancreatitis / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D014182:Transplantation, Autologous; D016896:Treatment Outcome