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Background: In selected patients with chronic pancreatitis, total pancreatectomy with islet autotransplantation can be effective for the treatment of intractable pain and avoidance of diabetes. Conventionally, islet infusion occurs intraoperatively after islet processing. A percutaneous transhepatic route in the immediate postoperative period is an alternate approach.METHODS: A prospectively collected database of all patients undergoing extensive pancreatectomy with islet autotransplantation for pancreatitis at a single institution was reviewed with attention to preoperative, intraoperative, and postoperative details. In particular, data pertaining to islet infusion were noted. Approval from the Institutional Review Board for the evaluation of human subjects was obtained.RESULTS: Over an 8 month period, 22 patients (14 women; median age 40.5) underwent extensive pancreatectomy with islet autotransplantation for pancreatitis. Twenty-one patients underwent total or completion pancreatectomy for pain secondary to pancreatitis; one patient underwent extended distal pancreatectomy for a disconnected duct after acute pancreatitis. Median operative time was 255 minutes (range 144 to 395), with median EBL 400cc (range 100 to 3000). Median elapsed time from pancreatic resection to islet transplantation transhepatically was 265 minutes (range 145 to 363). A median of 236,490 IEq were harvested (range 6341 to 1,168,725), or 3,315 IEq per kg, with a viability of 97.5%. Peak portal venous pressure during islet infusion was a median 13.5 mmHg (7 to 31mmHg). Postoperative complications occurred in 8 patients (36%), including those related to pancreatectomy (wound infection, abdominal abscess, deep vein thrombosis, acute renal failure, pneumonia, Clostridium difficile colitis, urinary tract infection, and biliary stricture) as well as those related specifically to islet transplantation (hepatic artery pseudoaneurysm, portal vein thrombosis). With median follow up of only 3.8 months, 21 patients (95%) demonstrate significant improvement in pain with decreased narcotic requirement, 3 (14%) are narcotic independent, and 5 (23%) are insulin free. CONCLUSIONS: Percutaneous transhepatic islet cell autotransplantation is feasible and safe. Given islet processing times, percutaneous infusion in the immediate postoperative period may be cost effective and time efficient for the surgeon. Further follow-up is needed to assess the effectiveness of total pancreatectomy with percutaneous transhepatic islet autotransplantation in terms of long term islet function and pain relief.