Current practices in islet cell autotransplantation

ABSTRACT

Introduction

Chronic pancreatitis and recurrent acute pancreatitis comprise a spectrum of disease that results in complications related to exocrine and endocrine insufficiency and chronic pain with narcotic dependence and poor quality of life. The mainstay of therapy has been medical and endoscopic therapy; surgery, especially total pancreatectomy, was historically reserved for few select patients as the obligate exocrine insufficiency and pancreatogenic diabetes (type 3C) are challenging to manage. The addition of islet cell autotransplantation after total pancreatectomy helps to mitigate brittle type 3c diabetes and prevents mortality related to severe hypoglycemic episodes and hypoglycemic unawareness. There have been more recent data demonstrating the safety of surgery and the beneficial long-term outcomes.

Areas covered

The purpose of this review is to describe the current practices in the field of islet cell autotransplantation including the selection and evaluation of patients for surgery, their preoperative work up and management, surgical approach, post-operative management and outcomes.

Expert opinion

Total pancreatectomy and islet cell autotransplantation has the ability to drastically improve quality of life and prevent brittle diabetes for patients suffering with chronic pancreatitis.

KEYWORDS:

• Chronic pancreatitis
• recurrent acute pancreatitis
• total pancreatectomy
• islet cell autotransplantation

Article highlights

• Surgical treatment in the form of total pancreatectomy for benign disease is often perceived as being radical, however the benefits outweigh the risks when paired with islet cell autotransplantation (both in terms of prevention of brittle diabetes and avoiding narcotic dependence).

• Success of TPIAT depends heavily on thorough evaluation, thoughtful patient selection, and cohesive multi-disciplinary management.

• Islet cell autotransplantation has been shown to avoid severe hypoglycemic episodes and hypoglycemic unawareness.

• Type 3C diabetes remains a poorly explored field in terms of research and clinical data reporting. Experiences from chronic pancreatitis centers will help to better understand this disease process.

• Future opportunities for basic and translational research include opportunities to maximize islet engraftment and growth into heterotopic tissues, as well as prevention of islet loss secondary to inflammation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.