Total Pancreatectomy and Islet autotransplantation

This is an analysis of a subset of patients at the University of Minnesota School of Medicine in Minneapolis from their vast experience of pancreatic and pancreatic islet transplantation. This paper discusses the management of patients with hereditary/genetic pancreatitis due to several causes which not only produces chronic pain but also an increased risk of pancreatic cancer. They have performed total pancreatectomy and autogenous islet transplantation in 80 patients over 35 years and have compared them with patients who have had total pancreatectomy and islet auto transplantation for a non-genetic cause of pancreatitis. The results are really quite impressive in that there was total pain relief which was sustained in 90% of the patients and two thirds had partial or full beta cell function. These patients were younger than the comparative cohort, had a longer period of pancreatic pain and with more fibrosis and there was a trend towards a lower yield of islets. Insulin independence was related to the severity of the fibrosis, the duration of pancreatitis and a higher number of islet cell equivalents per kilogram bodyweight. There was a significant improvement in health related quality of life from baseline. None of the patients in the entire cohort had cancer of pancreatic origin during what was quite a long period of follow up. The authors feel that in patients with hereditary/ genetic pancreatitis consideration should be offered an earlier total pancreatectomy and autogenous islet transplantation when there will be less fibrosis and a better islet retrieval.