ABSTRACT
Total pancreatectomy with islet autotransplantation, (TPIAT) is a complex surgical procedure for recurrent acute pancreatitis (RAP) and chronic pancreatitis, which can eliminate the risk of pancreatitis for pancreatic cancer and reduce the threat of severe diabetes mellitus. An increa-sing number of centers, here in the United States and internationally, are performing TPIAT and studies emerging from multiple centers highlight the benefits and persistent challenges of TPIAT for RAP and chronic pancreatitis. However, clear guidance on indications, contraindications, evaluation, timing of treatment and follow-up is lacking. The author reviews the history of TPIAT, and discusses the current state of TPIAT including indications of treatment, preoperative evaluations, surgical method, islet isolation and portal vein infusion, and postoperative management and a single center′s experience in TPIAT. A multiple center study with large numbers of patients will be critical to optimizing the successful application of this procedure.
ABSTRACT
Intraportal transplantation of islets is no longer considered to be an ideal procedure and finding the extrahepatic alternative site is becoming a subject of high priority. Herein, in this study, we would introduce our initial outcomes of using gastric submucosa (GS) and liver as sites of islet autotransplantation in pancreatectomized diabetic Beagles. Total pancreatectomy was performed in Beagles and then their own islets extracted from the excised pancreas were transplanted into GS (GS group, n=8) or intrahepatic via portal vein (PV group, n=5). Forty-eight hours post transplantation, graft containing tissue harvested from the recipients revealed the presence of insulin-positive cells. All recipients in GS group achieved euglycemia within 1 day, but returned to a diabetic state at 6 to 8 days post-transplantation (mean survival time, 7.16±0.69 days). However, all of the animals kept normoglycemic until 85 to 155 days post-transplantation in PV group (mean survival time, 120±28.58 days; P<0.01 vs. GS group). The results of intravenous glucose tolerance test (IVGTT) confirmed that the marked improvement in glycometabolism was obtained in intrahepatic islet autotransplantation. Thus, our findings indicate that the liver is still superior to the GS as the site of islet transplantation, at least in our islet autotransplant model in pancreatectomized diabetic Beagles.