title: Islet autotransplantation to preserve beta cell mass in selected patients with chronic pancreatitis and diabetes mellitus undergoing total pancreatectomy.
abstract: OBJECTIVE
  Islet autotransplantation (IAT) is performed in nondiabetic patients with chronic pancreatitis at the time of total pancreatectomy (TP) to minimize risk of postoperative diabetes. The role of TP-IAT in patients with chronic pancreatitis and C-peptide-positive diabetes is not established. We postulate that IAT can preserve beta cell mass and thereby benefit patients with preexisting diabetes undergoing TP.
  
  
  METHODS
  Preoperative metabolic testing, islet isolation outcomes, and subsequent islet graft function were reviewed for 27 patients with diabetes mellitus and chronic pancreatitis undergoing TP-IAT. The relationships between the results of preoperative metabolic testing and islet isolation outcomes were explored using regression analysis.
  
  
  RESULTS
  Mean islet yield was 2060 (SD, 2408) islet equivalents/kg. Peak C-peptide (from mixed meal tolerance testing) was the strongest predictor of islet yield, with higher stimulated C-peptide levels associated with greater islet mass. Half of the patients who had C-peptide levels measured after transplantation demonstrated C-peptide production at a level that conveys protective benefit in type 1 diabetes (≥ 0.6 ng/mL).
  
  
  CONCLUSIONS
  These findings provide proof of concept that significant islet mass can be isolated in patients with chronic pancreatitis and C-peptide-positive diabetes mellitus undergoing TP-IAT. Stimulated C-peptide may be a useful marker of islet mass before transplantation in these patients.
authors.affiliation: Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN 55455, USA. bell0130@umn.edu
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Wilhelm
authors.forename: Anh
authors.initials: A
authors.lastname: Ngo
authors.forename: David M
authors.initials: DM
authors.lastname: Radosevich
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schwarzenberg
authors.forename: A N
authors.initials: AN
authors.lastname: Balamurugan
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Hering
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D050417:Insulin-Secreting Cells / Q000378:metabolism / Q000473:pathology*; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human