Improved pancreatic islet isolation outcome in autologous transplantation for chronic pancreatitis.
Total or partial pancreatectomy followed by autologous islet transplantation is a therapeutic option for the treatment of refractory chronic pancreatitis (CP). Maximization of islet yields from fibrotic and inflamed organs is crucial for prevention of posttransplant diabetes. We adapted  technical advancements developed for islet allotransplantation toward islet autotransplantation. Eight patients (two men, six women; ages 24-58 years) underwent total (n = 7) or partial (n = 1) pancreatectomy for the treatment of CP refractory to maximal medical management.  Pancreata were preserved in UW solution (UW group) in initial three cases and the last five pancreata were preserved with pancreatic ductal injection followed by ET-Kyoto/oxygenated PFC solutions (DI+TLM group). Islets were isolated by modified Ricordi method and were purified only in one  case. All islet infusions were performed under general anesthesia via direct vein injection into the portal venous system with pressure monitoring. Total islet yields (129,314 ± 51,627 vs. 572,841 ± 116,934 IEQ, p < 0.04), islet yield/pancreas weight (1,233 ±  359 vs. 6,848 ± 847 IEQ/g, p < 0.003), and islet yield/patient body weight (1,951 ± 762 vs. 7,305 ± 1,531 IEQ/kg, p < 0.05) were significantly higher in the DI+TLM group when compared to the UW group. Pellet size was also higher (5.3 ± 0.3 vs.  13.5 ± 3.4 ml) in the DI+TLM group, suggesting that this method of preservation effectively protected pancreatic tissue against autolysis. First month posttransplant basal C-peptide and the secretory unit of islet transplant objects (SUITO) index were also higher in the DI+TLM group  when compared to the UW group (2.0 ± 0.3 vs. 1.4 ± 0.4 ng/ml and 42.6 ± 12.7 vs. 14.6 ± 5.6, respectively). There were no technical complications related to the infusion. Our results suggest that higher islet yields can be achieved even from chronically inflamed  and fibrotic organs using DI+TLM. The techniques applied for islet isolations from normal pancreata are showing promise for fibrotic pancreata from CP patients.
Baylor Simmons Transplant Institute, Dallas, TX 75246, USA. BashooN@baylorhealth.edu
Bashoo
B
Naziruddin
Shinichi
S
Matsumoto
Hirofumi
H
Noguchi
Morihito
M
Takita
Masayuki
M
Shimoda
Yasutaka
Y
Fujita
Daisuke
D
Chujo
Chad
C
Tate
Nicholas
N
Onaca
Jeffrey
J
Lamont
Naoya
N
Kobayashi
Marlon F
MF
Levy
D000241:Adenosine; D000328:Adult; D000493:Allopurinol; D001835:Body Weight; D002096:C-Peptide / Q000032:analysis; D011464:Epoprostenol; D005260:Female; D005466:Fluorocarbons; D005500:Follow-Up Studies; D005973:Glutamine; D005978:Glutathione; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D007328:Insulin; D007515:Islets of Langerhans / Q000166:cytology*; D016381:Islets of Langerhans Transplantation; D008278:Magnesium Sulfate; D008297:Male; D008875:Middle Aged; D009536:Niacinamide; D009926:Organ Preservation; D019188:Organ Preservation Solutions; D050500:Pancreatitis, Chronic / Q000628:therapy*; D011887:Raffinose; D014182:Transplantation, Autologous; D014199:Trehalose
D002096:C-Peptide; D005466:Fluorocarbons; D006895:Hydroxyethyl Starch Derivatives; D007328:Insulin; D019188:Organ Preservation Solutions; C431558:PFC-Kyoto solution; C055206:University of Wisconsin-lactobionate solution; D005973:Glutamine; D009536:Niacinamide; D000493:Allopurinol; D008278:Magnesium Sulfate; D014199:Trehalose; D011464:Epoprostenol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose