title: Remote processing of pancreas can restore normal glucose homeostasis in autologous islet transplantation after traumatic whipple pancreatectomy: technical considerations.
abstract: An emergency autologous islet transplant after a traumatic Whipple operation and subsequent total pancreatectomy was performed for a 21-year-old patient who was wounded with multiple abdominal gunshot wounds. After Whipple pancreatectomy, the remnant pancreas (63.5 g), along with other  damaged organs, was removed by the surgeons at Walter Reed Army Medical Center (WRAMC) and shipped to Diabetes Research Institute (DRI) for islet isolation. The pancreas was preserved in UW solution for 9.25 h prior to islet isolation. Upon arrival, the organ was visually inspected; the pancreatic  head was missing, the rest of the pancreas was damaged and full of blood; the tail looked normal. A 16-gauge catheter was inserted into the main duct and directed towards tail of the pancreas after the dissection of main duct in the midbody of the pancreas. The pancreas was distended with  collagenase solution (Roche MTF) through the catheter. During 10 min of intraductal delivery of enzyme, the gland was distended uniformly. No leakage of the solution was observed. The pancreas was transferred to a Ricordi chamber for automated mechanical and enzymatic digestion. Islets were  purified using a COBE 2991 cell processor. Islet equivalents (IEQ; 221,250) of 40% purity and 90% viability were recovered during the isolation, which were shipped back to WRAMC and infused by intraportal injection into the patient. Immediate islet function was demonstrated by the rapid elevation  of serum C peptide followed by insulin independence with near normal oral glucose tolerance test (OGTT) 1 and 2 months later. It is possible to restore near normal glucose tolerance with autologous islet transplantation after total pancreatectomy even with suboptimal number of islets while  confirming that islets processed at a remote site are suitable for transplantation.
authors.affiliation: Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL, USA.
authors.forename: Aisha
authors.initials: A
authors.lastname: Khan
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
authors.forename: Craig
authors.initials: C
authors.lastname: Shriver
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Guy
authors.forename: Amy E
authors.initials: AE
authors.lastname: Vertrees
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Wang
authors.forename: Xiumin
authors.initials: X
authors.lastname: Xu
authors.forename: Joel
authors.initials: J
authors.lastname: Szust
authors.forename: Camillo
authors.initials: C
authors.lastname: Ricordi
mesh_terms: D000241:Adenosine; D000493:Allopurinol; D002096:C-Peptide / Q000097:blood; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D005978:Glutathione; D006801:Humans; D007328:Insulin; D007515:Islets of Langerhans / Q000166:cytology*; D016381:Islets of Langerhans Transplantation; D008297:Male; D019188:Organ Preservation Solutions; D010180:Pancreatectomy; D011887:Raffinose; D014182:Transplantation, Autologous; D014948:Wounds, Gunshot / Q000628:therapy*; D055815:Young Adult
chemical_list: D002096:C-Peptide; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose