Distant processing of pancreas islets for autotransplantation following total pancreatectomy

BACKGROUND: Small duct chronic pancreatitis is associated with intractable pain and failure to thrive, usually unresponsive to conventional management approaches. Total pancreatectomy is considered after failure of medical in tervention. The major morbidity following total pancreatectomy is diabetes mellitus with its associated complications. This adverse outcome can be mit igated through autotransplantation of islets recovered from the pancreatect omy specimen. This approach has been limited historically owing to the abse nce of an on-site islet processing facility, We present the results from 5 pancreatectomized patients whose islets were prepared 1,500 miles away. METHODS: Five patients (4 women, 1 man, average age 42 years) who failed me dical therapy and were not candidates for longitudinal pancreaticojejunosto my underwent total/completion pancreatectomy (4 total, 1 completion) for in tractable symptoms from idiopathic small duct chronic pancreatitis, The res ected pancreata were preserved in ViaSpan solution and were transferred to an islet processing laboratory by commercial airliner and returned. The dis persed pancreatic islet tissue was infused into a portal vein tributary thr ough an operatively placed catheter after systemic heparinization, RESULTS: All 5 patients experienced complete relief from pancreatic pain; 2 had significant residual discomfort from underlying Crohn's disease. Three of the 5 patients had minimal or no insulin requirement after autotranspla ntation (median follow-up of 23 months); 1 patient continued with glycemic control difficulties related to Crohn's disease. One patient died 17 months following autotransplantation from an unrelated pneumonia, CONCLUSION: Total pancreatectomy with autologous islet transplantation can offer patients with idiopathic small duct chronic pancreatitis pain relief without the sequelae of diabetes mellitus and can be performed without an o n-site islet processing facility. All patients undergoing total/ completion pancreatectomy should be considered candidates for this procedure, Am J Su rg. 1999;177:423-427. (C) 1999 by Excerpta Medica, Inc.