Prevention of diabetes for up to 13 years by autoislet transplantation after pancreatectomy for chronic pancreatitis

Patients with chronic pancreatitis who undergo total pancreas resection ine vitably become diabetic unless their islets are autotransplanted to prevent diabetes. We studied patients who underwent this procedure to assess its l ong-term efficacy in providing stable glucose regulation. Six patients were followed for up to 13 (6.2 +/- 1.7) years after intrahepatic islet autotra nsplantation. From 290,000 to 678,000 islets were transplanted and no patie nts received drugs to control glucose levels postoperatively. Islet functio n was assessed by measurements of fasting plasma glucose (FPG), intravenous glucose disappearance rate (K-G), HbA(1c), insulin responses to intravenou s glucose and to arginine, and insulin secretory reserve. Patients were stu died two to four times each to obtain longitudinal data. Five of six patien ts remained free of insulin treatment and maintained FPG <126 mg/dl and HbA (1c) levels <6.5%. As a group, they maintained stable insulin secretory res erve, but insulin responses to glucose tended to decrease over time in thre e patients. K-G values correlated significantly with the number of islets o riginally transplanted. These data indicate that intrahepatic autoislet tra nsplantation can successfully maintain stable beta -cell function and norma l levels of blood glucose and HbA(1c) for up to 13 years after total pancre atectomy as treatment for chronic painful pancreatitis. This usually overlo oked procedure of intrahepatic islet transplantation designed to prevent di abetes in patients undergoing pancreatectomy for chronic pancreatitis shoul d be considered more often.