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Objective: To describe the safety and efficacy of autologous pancreatic islet transplants following an extended/ total pancreatectomy as a treatment for chronic pancreatitis.
Methods: Between January 2007 and October 2011, fifteen patients underwent an extended pancreatectomy for definitive treatment of chronic pancreatitis. Pancreata were surgically removed by the transplant division and sent to the islet processing facility. The islets were isolated using the Ricordi method, purified using Biocoll gradient and loaded into a sterile infusion bag containing transplant media for infusion. Three different enzymes were used for transplants since 2007.
Results: Nine patients underwent total pancreatectomy with six cases of near-total pancreatectomy. Mean age was 38 years (range 15-62) with a male to female ratio of 6:9. Fourteen of fifteen patients received and tolerated autologous islet cell infusion. One patient did not receive islet infusion secondary to infectious concerns. The mean islet equivalents were 202,903± 100,108 Islet equivalents (IEQs) with mean IEQ/kg of 3,016±1571 IEQ/kg. One year and three year actuarial patient survival was 100% and 91% (one case of bacteremia). There was low morbidity associated with pancreatectomy with autologous islet cell transplantation (no portal thrombosis, one pancreatic leak, one SMA injury). No patients required insulin prior to surgery. At mean follow up of 23±18 months, six patients (43%) remain insulin independent (two patients require oral hypoglycemics). Eight patients have a mean insulin requirement of only 6± 5 U/day. At one month follow-up, 13 patients (93%) had detectable c-peptide (mean 1.7±1.4 ng/mL). Overall, all patients reported a significant decrease in pain and narcotic requirements.

Conclusions: Autologous islet transplantation after extensive pancreatic resection for chronic pancreatitis is a safe and successful procedure. It offers definitive treatment of their diseased pancreas without the morbidity of brittle diabetes. The financial burden of chronic pancreatitis and poor health associated with diabetes can be successfully mitigated with pancreatectomy followed by isolation and autologous transplantation of insulin producing islet clusters. Ideally, patients should be offered this therapy earlier to decrease chronic abdominal pain and preserve endogenous endocrine function.