In patients with small-duct chronic pancreatitis, relief of pain can usually be achieved only by total pancreatectomy (removal of their pancreas). People with chronic debilitating pancreatitis or inflammation of the pancreas may want to consider having a pancreatectomy and auto islet transplant. During this type of surgery, a patient's whole pancreas is removed. Without a pancreas, a person becomes diabetic and needs to take insulin shots. However, to help minimize the need for insulin shots, the patient's own islets are isolated from the pancreas and are put back into the patient through a catheter into the portal vein in the liver. The islets lodge in the liver or spleen and start producing insulin for the patient. With this type of procedure, the patient does not need to take immunosuppressive medications to prevent rejection of the islets by their body because the islets that are infused originally came from their own pancreas.
The probability of islet success is highest in those individuals who have had no previous direct surgery on the body and tail of the pancreas (such as a Puestow or Whipple procedure). For relief from the debilitating pain of chronic pancreatitis, patients have to accept the possibility of diabetes. If diabetes is prevented, it is a bonus.
Expectations
Outcomes
Qualification Criteria
FAQs
What to Expect
During a pancreatectomy and auto islet transplant, surgeons remove the patient's pancreas. Then, they isolate the islets from the pancreas and infuse the islets back into the patient's portal vein in the liver. The islets lodge in the liver or spleen and start producing insulin.
About half of patients who have this procedure do not need to take insulin. Our experience indicates that if the patient has had previous surgery on the head or tail of the pancreas, they are more likely to need to take insulin shots after the pancreatectomy and auto islet transplant.
Because the patient's own islets are used, they do not need to take immunosuppressive medications after surgery.
Top of page
Outcomes
Our most recent results, which were presented at the 2005 annual Clinical Congress of the American College of Surgeons, indicate that a pancreatectomy and auto islet transplant can provide significant pain relief to most patients with chronic pancreatitis. In a study of 140 patients who had undergone pancreatectomy for pain associated with chronic pancreatitis, about 63% of patients had complete pain relief and 22% had partial pain relief. The remaining 15% of patients indicated that they had no change in the degree of pain after surgery.
Typically, patients who have had a pancreatectomy become diabetic after the surgery. During a pancreatectomy, the patient's pancreas is removed. The pancreas contains islets which produce insulin. Without an external source of insulin (such as insulin injections or an insulin pump), a patient who had a pancreatectomy would not survive.
However, at the University of Minnesota Medical Center, a patient can have a procedure called an autoislet transplant after their pancreatectomy. This procedure reduces the patient's need to inject themselves with insulin to manage their diabetes. During an autoislet transplant, the patient's islets are isolated from the rest of their pancreas and then transplanted back into them. Islet isolation is a very sophisticated process performed in a laboratory that meets the Good Manufacturing Practice standards set by the U.S. Food and Drug Administration. At present, the University of Minnesota Medical Center is one of only two hospitals that routinely performs pancreatectomy and auto islet transplants for patients with chronic pancreatitis.
Among 51 patients who received more than 2,000 islet equivalents per kilogram, 72% could manage their diabetes without regular injections of insulin. Of these patients, about 47% did not need insulin at all after their surgery and 25% needed only intermittent insulin treatments.
In conclusion, a total or near total pancreatectomy effectively treats pancreatitis pain in most patients who have not received relief of pain through medical management or other procedures. Auto-islet transplantation is a safe addition to extensive pancreatic resection that can prevent surgically induced diabetes, fulfilling the principle of preserving pancreatic function and relieving pain to the fullest extent possible. Patients undergoing pancreatectomy, even with an auto-islet transplant, must be willing to accept diabetes for relief of pain, but an attempt to prevent diabetes should always be made by performing an auto-islet transplant. Read more about our most recent results.
Top of page
How Do I Qualify for One?
To obtain more information about a pancreatectomy and auto islet transplantation, please call Ann Marie Papas at 612-625-5609.
Before your surgery, it is important that you have identified and met a doctor near your home who will be comfortable managing your health care after your pancreatectomy and auto islet transplant. This doctor could be an internist, a diabetologist, or a general practitioner. The doctor you choose must be willing to communicate directly with our doctors regarding your care after your surgery. We are willing to answer any questions that may arise regarding your care.
Inclusion and Exclusion Criteria
People need to meet the following criteria in order to qualify for a pancreatectomy and auto islet transplant (inclusion criteria):
-
Patients who need a total pancreatectomy, or partial pancreatectomy when a completion pancreatectomy might be required in the future.
-
Non-diabetic at the time of pancreatectomy, or mildly diabetic depending on the c-peptide results (c-peptide is indication of islet function). If the patient does not require insulin pre-pancreatectomy, we don't need c-peptide levels.
-
Benign disease of the pancreas (non cancerous)
To qualify for a pancreatectomy and auto islet transplant, people should not have the following conditions (exclusion criteria):
Top of page
Return to: Medical School : Academic Health Center : myU : U of M Home
