title: Autologous islet transplantation with remote islet isolation after pancreas resection for chronic pancreatitis.
abstract: OBJECTIVE
  Autologous islet transplantation is an elegant and effective method for preserving euglycemia in patients undergoing near-total or total pancreatectomy for severe chronic pancreatitis. However, few centers worldwide perform this complex procedure, which requires interdisciplinary coordination and access to a sophisticated Food and Drug Administration-licensed islet-isolating facility.
  
  
  OBJECTIVE
  To investigate outcomes from a single institutional case series of near-total or total pancreatectomy and autologous islet transplantation using remote islet isolation.
  
  
  METHODS
  Retrospective cohort study between March 1, 2007, and December 31, 2013, at tertiary academic referral centers among 9 patients (age range, 13-47 years) with chronic pancreatitis and reduced quality of life after failed medical management.
  
  
  METHODS
  Pancreas resection, followed by transport to a remote facility for islet isolation using a modified Ricordi technique, with immediate transplantation via portal vein infusion.
  
  
  METHODS
  Islet yield, pain assessment, insulin requirement, costs, and transport time.
  
  
  RESULTS
  Eight of nine patients had successful islet isolation after near-total or total pancreatectomy. Four of six patients with total pancreatectomy had islet yields exceeding 5000 islet equivalents per kilogram of body weight. At 2 months after surgery, all 9 patients had significantly reduced pain or were pain free. Of these patients, 2 did not require insulin, and 1 required low doses. The mean transport cost was $16,527, and the mean transport time was 3½ hours.
  
  
  CONCLUSIONS
  Pancreatic resection with autologous islet transplantation for severe chronic pancreatitis is a safe and effective final alternative to ameliorate debilitating pain and to help prevent the development of surgical diabetes. Because many centers lack access to an islet-isolating facility, we describe our experience using a regional 2-center collaboration as a successful model to remotely isolate cells, with outcomes similar to those of larger case series.
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Denise S
authors.initials: DS
authors.lastname: Tai
authors.affiliation: Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Na
authors.initials: N
authors.lastname: Shen
authors.affiliation: Department of Surgery, University of California, San Francisco.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Szot
authors.affiliation: Department of Surgery, University of California, San Francisco.
authors.forename: Andrew
authors.initials: A
authors.lastname: Posselt
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Feduska
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Andrew
authors.initials: A
authors.lastname: Habashy
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles4UCLA Center for Pancreatic Diseases, University of California, Los Angeles.
authors.forename: Barbara
authors.initials: B
authors.lastname: Clerkin
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Erin
authors.initials: E
authors.lastname: Core
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles4UCLA Center for Pancreatic Diseases, University of California, Los Angeles.
authors.forename: O Joe
authors.initials: OJ
authors.lastname: Hines
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles4UCLA Center for Pancreatic Diseases, University of California, Los Angeles.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Reber
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles2Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles4UCLA Center for Pancreatic.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Lipshutz
mesh_terms: D000293:Adolescent; D000328:Adult; D002469:Cell Separation / Q000379:methods*; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D050500:Pancreatitis, Chronic / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013048:Specimen Handling / Q000191:economics; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult