AUTOLOGOUS ISLET TRANSPLANTATION TO PREVENT DIABETES AFTER PANCREATICRESECTION

Background Extensive pancreatic resection for small-duct chronic pancr eatitis is often required for pain relief, but the risk of diabetes is a major deterrent. Objective Incidence of pain relief, prevention of diabetes, and identification of factors predictive of success were the goals in this series of 48 patients who underwent pancreatectomy and islet autotransplantation for chronic pancreatitis. Patients and Metho ds Of the 48 patients, 43 underwent total or near-total (>95%) pancrea tectomy and 5 underwent partial pancreatectomy. The resected pancreas was dispersed by either old (n = 26) or new (n = 22) methods of collag enase digestion. islets were injected into the portal vein of 46 of th e 48 patients and under the kidney capsule in the remaining 2. Postope rative morbidity, mortality, pain relief, and need for exogenous insul in were determined, and actuarial probability of postoperative insulin independence was calculated based on several variables. Results One p erioperative death occurred. Surgical complications occurred in 12 of the 48 patients (25%): of these, 3 had a total (n = 27); 8, a near-tot al (n = 16); and 1, a partial pancreatectomy (p = 0.02). Most of the 4 8 patients had a transient increase in portal Venous pressure after is let infusion, but no serious sequelae developed. More than 80% of pati ents experienced significant pain relief after pancreatectomy. Of the 39 patients who underwent total or near-total pancreatectomy, 20 (51%) were initially insulin independent. Between 2 and 10 years after tran splantation, 34% were insulin independent, with no grafts failing afte r 2 years. The main predictor of insulin independence was the number o f islets transplanted (of 14 patients who received >300,000 islets, 74 % were insulin independent at >2 years after transplantation). In turn , the number of islets recovered correlated with the degree of fibrosi s (r = -0.52, p = 0.006) and the dispersion method (p = 0.005). Conclu sion Pancreatectomy can relieve intractable pain caused by chronic pan creatitis. Islet autotransplantation is safe and can prevent long-term diabetes in more than 33% of patients and should be an adjunct to any pancreatic resection. A given patient's probability of success can be predicted by the morphologic features of the pancreas.