Total pancreatectomy and islet cell autotransplantation as a means of treating patients with genetically linked pancreatitis

Pancreatic islet autotransplantation with total pancreatectomy for chronic pancreatitis

“…23,24 Chronic pancreatitis patients undergoing total pancreatectomy are candidates for islet transplantation. [25][26][27][28][29][30] Other indications for islet transplantation are uncontrolled diabetes with pancreatic resection procedures or irreversible insufficiency of endocrine/exocrine function due to chronic pancreatitis. In addition, patients who have undergone near-total pancreatectomy for uncontrolled pancreatic pseudocyst or for pancreatic fistula associated with chronic pancreatitis are candidates for islet transplantation.…”

Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

“…Indeed, in the first 135 cases of TP-IAT for CP at UMN, only 16% were attributed to alcohol, and 60% were idiopathic (Jie et al, 2005); in more recent cases (Sutherland et al, 2011b) fewer are classified as idiopathic and more as genetic in origin because of the identification of genes associated with CP as well as pancreatic cancer (Braganza et al, 2011). In the series at the University of Cincinnati, only 14% of the cases of CP were attributed to alcohol (Ahmad et al, 2005;Sutton et al, 2010). Cigarette smoking is also a major risk factor for CP (Maisonneuve et al, 2005;Talamini et al, 1999).…”

“…The main criterion for success of the islet autograft per se is whether insulin independence is maintained or surgical diabetes made milder. The overall outcome, however, depends as much on the clinical response as on the metabolic results, specifically whether the patient's pain is reduced or eliminated, narcotic analgesics withdrawn, and the quality of life (QOL) improved (Bellin et al, 2010b;Bellin et al, 2011b;Bellin et al, 2011c;Billings et al, 2011;Rafael et al, 2008;Sutton et al, 2010).…”

“…1). The world literature as of 2011 contains reports of about 700 IATs, including the 400 UMN cases cited previously and those done elsewhere (Ahmad et al, 2005;Argo et al, 2008;Clayton et al, 2003;Dixon et al, 2008;Farkas & Pap, 1997;Garcea et al, 2009;Jindal et al, 1998;Oberholzer et al, 2000;Rodriguez et al, 2003;Sarbu et al, 2005;Sutton et al, 2010;Takita et al, 2010;Takita et al, 2011a;Teuscher et al, 1998;Watkins et al, 2003;Webb et al, 2008;White et al, 1998;White et al, 2001;) [2622]. After UMN, the next largest series are at the University of Cincinnati (more than 100) and the University of Leicester (more than 60).…”

“…The largest series published to date on patients undergoing pancreatectomy and IAT have come from the University of Minnesota (Farney et al, 1991;Gores et al, 1992;Gruessner et al, 2004;Jie et al, 2005;Najarian et al, 1979;Najarian et al, 1980;Sutherland et al, 1978;Sutherland et al, 1980a;Sutherland et al, 2004a;Sutherland et al, 2009a;Sutherland et al, 2009b;Sutherland et al, 2011b;Wahoff et al, 1995a) (>400), the University of Cincinnati (Ahmad et al, 2005;Rodriguez et al, 2003;Sutton et al, 2010) (>100), the University of Leicester (Clayton et al, 2003;;Garcea et al, 2009;White SA et al, 1998;White SA et al, 2001;Webb et al, 2008) (>50 cases), but there are many center that are building their series (Argo et al, 2008;Berney T et al, 2000;Desai et al, 2011;Dixon et al, 2008;Jahansouz et al, 2011;Takita et al, 2010;Takita et al, 2011b;Valente et al, 1986) The reports from these centers largely focus on metabolic outcomes, QOL, and pain reduction., but there are many publications on specialized aspects of TP-IAT as have been referenced in this chapter.…”