Islet cell transplantation for pancreatitis – pro
Islet cell transplantation is used to treat Type 1 diabetes mellitus and diabetes mellitus secondary to surgical removal of the pancreas for chronic pancreatitis. In teh latter case the cells transplanted coem form the patient’s own pancreas and the procedure is called autologous islet stem cell transplantation. I will not address PCT for diabetes, which is generally considered to be experimental.
For pancreatitis, near total or total pancreatic resection can alleviate pain in patients with severe chronic resection. Autologous islet cell transplantation can preserve islet cell function in patients undergoing this procedure. The islet cell transplantation procedure involves the infusion of islet cells into the liver by portal embolization, where the cells function as a free graft. The liver’s dual vascular supply allows embolization of isolated pancreatic islets by cannulating the umbilical vein, a tributary of the mesenteric venous system, or by transcutaneous, transhepatic cannulation of the portal vein itself. The terminal portal venule can be occluded without infarcting the transplant site.
Rodriguez Rilo, et al. (2003) reported on the results of autologous islet cell transplantation in a consecutive series of patients from one center who received total or near-total pancreatic resection for severe, refractory chronic pancreatitis. From February 2000 to February 2003, a total of 22 patients, whose median age was 38 years, underwent pancreatectomy and autologous islet cell transplantation. Sixty-eight percent of the patients had either a minor or major complication. Major complications included acute respiratory distress syndrome (n = 2), intra-abdominal abscess (n = 1), and pulmonary embolism (n = 1). All patients demonstrated C-peptide and insulin production indicating graft function. Postoperatively, forty-one percent of subjects were insulin independent, and 27% required less than 10 units of insulin per day, and the remaining 7 patients require between 15 and 40 units of insulin per day. All patients had preoperative pain and had been taking opioid analgesics; 82% no longer required analgesics postoperatively. The investigators concluded that pancreatectomy with autologous islet cell transplantation can alleviate pain for patients with chronic pancreatitis and preserve endocrine function.
Jie, et al. (2005) reported on outcomes of one center’s experience with 137 patients undergoing autologous islet cell transplantation for pancreatectomy since 1997. Follow-up data was available in 120 patients; 63% of the patients had complete relief from pain, 22% experienced partial relief, and 15% were unchanged. Of patients with complete pancreatectomy since 1995 (n=73), all but one pediatric patient (n=22) transplanted with less than or equal to 2000 IEQ/kg islets required insulin post-pancreatectomy. Of patients receiving more than 2000 IEQ/kg islets (n=51), 47% were completely insulin independent while 25% were intermittently insulin-treated. The investigators concluded that autologous islet cell transplantation should be considered in patients undergoing primary pancreatic resection for the treatment of refractory pain associated with small duct chronic pancreatitis.
Clayton, et al. (2003) reported on a single center’s experience with autologous islet cell transplantation for total or partial pancreatectomy from September 1994 to July 2001. Forty patients had been transplanted, with follow-up times range from 6 months to 7 years. At two years post transplant, 18 patients had a median hemoglobin A1c of 6.6% (5.2-19.3%), fasting C-peptide of 0.66 ng/mL (0.26-2.65 ng/mL), and required a median of 12 (0-45) units of insulin per day. Five patients with 6-year follow-up data had a median hemoglobin A1c of 8% (6.1-11.1%), fasting C peptide of 1.68 ng/mL (0.9-2.78 ng/mL), and required a median of 43 (6-86) units of insulin per day. The investigators reported that these data demonstrate that up to 6 years after autologous islet cell transplantation, the grafts continue to function, but that over the time period studied, the level of function appears to be decreasing. The investigators reported that the majority of patients no longer required opiate analgesia.