Simultaneous total pancreatectomy with islets autotransplantation – one year follow-up

Background: Enzyme supplementation and analgesia is a basic treatment in patients with chronic pancreatitis with pain syndrome. Absence of pain relief after conventional treatment and endosurgery should be an indication for surgery. Islets autotransplantation performed simultaneously with pancreatectomy gives a chance to prevent iatrogenic diabetes or to alleviate its course.
Material/Methods: Pancreas was perfused with collagenase/protease solution and then digested in Riccordi chamber. Procured suspension of islets and exocrine tissue was infused into the liver through the portal vein. One year follow-up protocol involved C-peptide level, insulin requirement, HbA1c and quality of life assessment.
Results: Complete pain relief has been achieved after pancreatectomy. Although insulin-independence has not been achieved, C-peptide level is 0.6 ng/mL and insulin dosage from 14 to 20 units/day indicate partial islets function with glucose level between 60 up to 180 mg%. No acute insulin treatment complication has been observed. HbA1c is maintained <6.5 mg%. Patient has estimated his quality of life better then it was expected before the surgery.
Conclusions: Islet autotransplantation should be performed in every case of
non-diabetic patient with chronic pancreatitis qualified for pancreatectomy.
Islet autotransplantation is a safety surgical procedure and may protect from
iatrogenic diabetes in patients after total pancreatectomy.

Keywords: case report, clinical outcome