Total pancreatectomy with islet autologous transplantation: the cure for chronic pancreatitis?

Abstract

Chronic pancreatitis (CP) is a debilitating disease that leads to varying degrees of pancreatic endocrine and exocrine dysfunction. One of the most difficult symptoms of CP is severe abdominal pain, which is often challenging to control with available analgesics and therapies. In the last decade, total pancreatectomy with autologous islet cell transplantation has emerged as a promising treatment for the refractory pain of CP and is currently performed at approximately a dozen centers in the United States. While total pancreatectomy is not a new procedure, the endocrine function-preserving autologous islet cell isolation and re-implantation have made the prospect of total pancreatectomy more acceptable to patients and clinicians. This review will focus on the current status of total pancreatectomy with autologous islet cell transplant including patient selection, technical considerations, and outcomes. As the procedure is performed at an increasing number of centers, this review will highlight opportunities for quality improvement and outcome optimization.

Figure 1

Operative pancreatectomy. (a) Intra-operative identification of the splenic artery. (b) Mobilization of the pancreas and spleen. (c) Complete pancreatic explantation.

Figure 2

The pancreas explant after it has been infused with buffering solution and is ready to undergo mechanical digestion.

Figure 3

Islets being infused via arterial-line tubing into the superior mesenteric vein.