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Autologous islet transplantation following surgery to remove all or part of the pancreas appears to be safe and effective for alleviating pain from severe chronic pancreatitis and may help prevent surgically induced diabetes, according to data published in JAMA Surgery.
“Despite the effective pain relief and insulin independence reported in many patients after pancreatectomy and [autologous islet transplantation], few medical centers worldwide offer such treatment options for patients with [chronic pancreatitis],” Denise S. Tai, MD, of the University of California, Los Angeles, and colleagues wrote.
“Possible reasons include the limited access to and cost of maintaining an islet-isolating facility, a lack of consensus regarding indications for and timing of surgical intervention, and the paucity of data on long-term outcomes.”
To learn more, the researchers conducted a retrospective cohort study of nine patients aged 13 to 47 years with chronic pancreatitis who underwent pancreas resection followed by transport to a remote facility for islet isolation and immediate transplantation through a portal vein infusion.
Results indicated that eight patients had successful islet isolation after total or near-total pancreatectomy. Of six patients with total pancreatectomy, four had islet yields that exceeded 5,000 islet equivalents per kilogram of body weight.
All nine patients experienced significant reductions in pain or were free from pain after 2 months, according to the researchers. Of these patients, two did not require insulin and one required low doses.
Mean transport cost was $16,527, and mean transport time was 3.5 hours.
Although the study had limitations, such its retrospective design, low volume of patients and length of follow-up, the researchers noted that its size was reasonable given the rarity of the procedure.
“Chronic pancreatitis is marked by difficulty in diagnosis, heterogenous etiologies, and need for complex pancreatic surgery and access to an experienced islet-isolating facility,” they wrote. “However, with the practice of geographically remote islet isolation by means of institutional collaboration, many more patients with [chronic pancreatitis] may have access to and may greatly benefit from this procedure.”
