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Islet transplant with remote isolation viable option for chronic pancreatitis
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Pancreas removal or resection followed by autologous islet transplantation is safe and effective to help relieve pain and prevent the development of surgical diabetes in patients with severe chronic pancreatitis, according to research published in JAMA Surgery.
The success of a cooperative effort in California led researchers to conclude that creating regional collaborations between local surgical centers and specialized centers with islet-isolating capabilities would allow remote isolation of cells and improve outcomes.
“This complex procedure, a total pancreatectomy and auto-islet transplant, can be performed using the expertise located at distant centers,” Gerald S. Lipshutz, MD, MS, of the David Geffen School of Medicine, UCLA, told Endocrine Today. “It allows patients to remain either in or close to their community with the support of friends and family when they undergo such a large operation.”
Gerald S. Lipshutz
Lipshutz, along with Denise S. Tai, MD, and colleagues, conducted a retrospective cohort study involving nine patients (five males) aged 13 to 47 years with chronic pancreatitis and reduced quality of life after failed medical management.
To investigate outcomes of near-total or total pancreatectomy and autologous islet transplantation using remote islet isolation, the researchers followed patients at tertiary academic referral centers from March 1, 2007, to 2013.
Patients underwent pancreatic resection. Packaged in three sterile layers, each pancreas was transported to a remote facility for islet isolation using a modified Ricordi technique. On return, immediate transplantation was done via portal vein infusion.
The scientists primarily looked at islet yield, pain assessment, insulin requirement, costs and transport time.
After near-total or total pancreatectomy, eight of nine patients had successful islet isolation; four of six patients with total pancreatectomy demonstrated islet yields >5,000 islet equivalents per kilogram of body weight.
All patients had significantly reduced pain or were pain-free 2 months after surgery. Two patients did not require insulin, and one patient required low doses. On average, transport cost was $16,527 and transport time was 3.5 hours.
“We were able to use our local expertise for the total pancreatectomy and postoperative care and also use the expertise of our collaborating center for the islet isolation,” Lipshutz said. “As such, were we able to report similar results to what others have seen when they have had patients come to their center where both the surgery and islet isolation were performed at the same location.”
Because of the multidisciplinary coordination and care required by patients undergoing pancreatic resection with autologous islet transplantation, the procedure is performed at only a few centers worldwide, the researchers said.
“Potentially, this would allow for more patients to be offered the procedure by utilizing a distant center’s expertise for islet isolation,” Lipshutz said. – by Allegra Tiver
For more information:
Gerald S. Lipshutz, MD, MS, can be reached at the Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Room 77-120, Center for the Health Sciences, Los Angeles, CA 90095; email: glipshutz@mednet.ucla.edu.
Disclosure: The researchers report no relevant financial disclosures.
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