Islet auto transplantation following total pancreatectomy: a long-term assessment of graft function.
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.
Webb
M'Balu A
MA
Department of Hepatobiliary Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom. balu.webb@uhl-tr.nhs.uk
Illouz
Severine C
SC
Pollard
Cristina A
CA
Gregory
Robert
R
Mayberry
John F
JF
Tordoff
Simon G
SG
Bone
Margaret
M
Cordle
Christine J
CJ
Berry
David P
DP
Nicholson
Michael L
ML
Musto
Patrick P
PP
Dennison
Ashley R
AR
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D048909:Diabetes Complications / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006085:Graft Survival; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use; D007515:Islets of Langerhans / Q000378:metabolism / Q000601:surgery*; D016381:Islets of Langerhans Transplantation; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000601:surgery*; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human