Pancreatic islet autotransplantation combined with total pancreatectomy for the treatment of chronic pancreatitis - the Leicester experience

Islet autotransplantation offers the potential for preventing the surgicall y induced diabetes that is an inevitable consequence of total pancreatectom y. This paper describes the first islet autotransplant programme in the Uni ted Kingdom and the first series in the world to use the spleen as a site f or the islet graft. Over an 11 month period, 7 patients underwent total pan createctomy for chronic pancreatitis combined with a simultaneous islet aut otransplant. All 7 patients had normal glucose-tolerance levels and normal C-peptide levels pre-operatively. In 6 patients, islets were embolized into the liver via the portal vein (median transplanted volume=8.5 mi). In addi tion, 3 patients received islets into the splenic sinusoids via a short gas tric vein (median transplanted volume=4 mi). One patient received islets in to the spleen alone. One patient died of a stroke 4 weeks post transplantat ion. Two patients have achieved insulin independence, with a further two pa tients achieving "transient" insulin independence (<1 month). The remaining 2 patients, although requiring reduced insulin doses, have not achieved in sulin-independence. However, all patients have C-peptide levels within the normal range. In trying to explain these findings, split proinsulin levels were measured and found to be elevated. High levels of split proinsulin cro ss react with the C-peptide assay and this would explain the falsely elevat ed C-peptide levels. Indeed insulin levels in these patients were all below the normal range. These findings would suggest that the use of C-peptide l evels as the "gold standard" for monitoring islet autograft function, may r equire reappraisal.