Total Pancreatectomy and Islet Autotransplantation
A Breakthrough in the Treatment of Pancreatitis
- What is autologous islet cell transplantation?
- Why is autologous islet cell transplantation recommended after removal of the pancreas?
- Who is a candidate for autologous islet cell transplantation?
- How does autologous islet cell transplantation differ from allogeneic islet cell transplantation?
- What is the outlook for someone who has had an autologous islet cell transplantation procedure?
A. Autologous islet cell transplantation (AIT) is a procedure that is performed to prevent diabetes or reduce the severity of diabetes after removal of the pancreas (pancreatic resection). After pancreatic tissue is removed during surgery, insulin-producing islet cells are immediately isolated from the pancreas in a lab. These islet cells are then transplanted into the patient's liver through a major blood vessel called the portal vein. The islet cells continue to produce insulin to control blood sugar levels in the body.
Other names for autologous islet cell transplantation include:
- Islet autotransplantation, islet autotransplant
- Autotransplantation of islet cells, autotransplant of islet cells
- Autoislet transplantation, autoislet transplant
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A. The pancreas is a large gland located behind the stomach. One of the key duties of the pancreas is to produce the hormones insulin and glugagon to metabolize sugars (glucose) in the blood. The cells in the pancreas that produce these hormones are called islet cells. Insulin is needed by the body to convert blood sugars into energy. Without insulin, there is a build-up of sugar in the blood, which passes into urine where it is eventually eliminated, leaving the body without its main source of fuel. Diabetes is the name for this disorder that occurs when the body does not produce enough insulin.
When the pancreas is removed, the body loses its ability to produce insulin, so diabetes will occur. Typically, the form of diabetes that occurs after pancreas resection is very severe and difficult to control. It's known as "brittle diabetes," and can lead to many complications, including heart and kidney disease, vision problems, poor circulation, foot conditions, and other life-threatening problems.
Some conditions, such as painful chronic pancreatitis or multiple recurrent episodes of pancreatitis that is not controlled by standard medical and surgical treatments, may require the removal of the pancreas to relieve severe symptoms. In the past, physicians have been hesitant to consider this option, because of the impending threat of development of brittle diabetes. It was a tough choice--relieving the pain of one serious condition, only to know that another complex problem would result.
But now, physicians can prevent or reduce the effects of diabetes after pancreas removal by performing autologous islet cell transplantation. Benefits of autologous islet cell transplantation include:
- Prevention or reduced risk for the development of diabetes in patients who did not have it before
- In people who already have diabetes, AIT decreases the chance for the development of very difficult-to-control brittle diabetes
- Approximately 30-40 percent of patients who have AIT will not require insulin treatment after the first year or two. For the 60 percent of people who do require insulin, their diabetes is typically much more easily managed
Most people who have had total pancreatectomy and AIT for pancreatitis find a dramatic improvement in their abdominal pain, and, in most (70 percent) patients, the use of narcotic pain medicine is eliminated. And because the islet cells used in this procedure belong to the patient, there is no risk for immune reactions.
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Q. Who is a candidate for autologous islet cell transplantation?
A. People who are candidates for autologous islet cell transplantation include patients with debilitating pain from chronic pancreatitis or those with multiple episodes of recurrent acute pancreatitis that has not been successfully controlled with other treatments.
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A. Autologous means that the patient is receiving his or her own tissue for transplant. Allogeneic refers to the transplantation of tissue from one person to another.
Allogeneic islet transplantation is not used to prevent type 1 diabetes--it is used to treat it when is it already present. It's being studied as an alternative to whole-organ pancreas transplant for people with severe diabetes. In this procedure, islet cells are taken from a cadaver pancreas and then isolated and transplanted through the portal vein into the patient's liver. There is no surgery required. Because the islet cells came from a donor organ, the patient will require immunosuppressive therapy after treatment. »More information about allogeneic islet cell transplantation
The University of Chicago Medicine is one of the select few hospitals in the nation that is performing both autologous and allogeneic islet cell transplantation.
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Q. What is the outlook for someone who has had an autologous islet cell transplantation procedure?
A. As noted earlier, most patients (about 70 percent) experience dramatic pain relief after total pancreatectomy with autologous islet cell transplantation. Approximately 30-40 percent of patients who have AIT will not require insulin injections after the procedure. Other patients may need to take daily insulin and monitor their blood glucose closely, but the severity of their diabetes is less compared to patients who did not undergo AIT.
Although AIT has been performed for more than 25 years, there is only limited data on long-term results for patients who have had the procedure. Current information suggests that there is a slow, steady decline of transplanted islet function over many years after the procedure, but that significant and beneficial islet function persists for 10 years and even longer after the original operation. This experience should be balanced against the observation that as many as 50 to 80 percent of patients with chronic pancreatitis may develop diabetes within years, regardless of medical and surgical therapy.
Each case is different, and multiple factors affect the level of insulin independence a patient will experience. Studies show that these factors include the following:
- The condition of the pancreas at the time of the procedure, including the type of prior operations that may have been carried out. These factors affect the amount of islet cells that can be transplanted. A certain amount of healthy islet cells are required.
- The overall health of the patient and presence of other diseases that may affect outcome
- The patient's body mass index (BMI). People with a BMI below 30 have a greater chance of not needing insulin
- The presence of concurrent type-2 diabetes
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