Total Pancreatectomy With Islet Cell Auto-Transplantation: Update and Outcomes From Major Centers

Springer Science and Business Media LLC - Tập 12 - Trang 350-358 - 2014
Noaman S. Ali1, R. Matthew Walsh1
1Cleveland Clinic, Digestive Disease Institute, Cleveland, USA

Tóm tắt

Chronic pancreatitis is the result of irreversible damage to pancreatic acinar cells, and can result in debilitating chronic pain for patients. Treatment centers on pain relief, often with chronic narcotic use. Surgical therapy consists of both resection procedures to remove affected pancreatic parenchyma and drainage procedures to facilitate drainage of the main pancreatic duct. Total pancreatectomy historically was utilized in extreme cases due to the brittle glucose control that followed from the total loss of islet cells. Total pancreatectomy with islet cell auto-transplantation (TP-AIT) is gaining in popularity due to the maintenance of beta cell mass and the ability of patients to potentially be insulin independent post-operatively. TP-AIT is very helpful in the treatment of pain for patients with chronic pancreatitis. The overall majority of patients have an improvement in pain and quality-of-life scores. AIT also allows the majority of patients to have minimal insulin requirements post-operatively. With proper patient selection, these outcomes can be achieved.

Tài liệu tham khảo

Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med. 1995;332(22):1482–90. Blondet JJ, Carlson AM, Kobayashi T, et al. The role of total pancreatectomy and islet autotransplantation for chronic pancreatitis. Chest Surg Clin N Am. 2007;87(6):1477–501. x. Morgan K, Owczarski SM, Borckardt J, et al. Pain control and quality of life after pancreatectomy with islet autotransplantation for chronic pancreatitis. J Gastrointest Surg. 2012;16(1):129–33. discussion 133–4. Whipple AO. Radical surgery for certain cases of pancreatic fibrosis associated with calcareous deposits. Ann Surg. 1946;124(6):991–1006. Ong SL, Gravante G, Pollard CA, et al. Total pancreatectomy with islet autotransplantation: an overview. HPB (Oxford). 2009;11(8):613–21. Najarian JS, Sutherland DE, Matas AJ, et al. Human islet autotransplantation following pancreatectomy. Transplant Proc. 1979;11(1):336–40. Sutherland DE, Radosevich DM, Bellin MD, et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis. J Am Coll Surg. 2012;214(4):409–24. discussion 424–6. This is the case series from the University of Minnesota, the largest reported with over 400 patients. Desai CS, Stephenson DA, Khan KM, et al. Novel technique of total pancreatectomy before autologous islet transplants in chronic pancreatitis patients. J Am Coll Surg. 2011;213(6):e29–34. Sutton JM, Schmulewitz N, Sussman JJ, et al. Total pancreatectomy and islet cell autotransplantation as a means of treating patients with genetically linked pancreatitis. Surgery. 2010;148(4):676–85. discussion 685–6. Walsh TN, Rode J, Theis BA, et al. Minimal change chronic pancreatitis. Gut. 1992;33(11):1566–71. Walsh RM, Saavedra JR, Lentz G, et al. Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis. J Gastrointest Surg. 2012;16(8):1469–77. This paper highlights the improvement in quality of life and opoid requirements post operatively. Bahuva R, Walsh RM, Kapural L, et al. Morphologic abnormalities are poorly predictive of visceral pain in chronic pancreatitis. Pancreas. 2013;42(1):6–10. Lundberg R, Beilman GJ, Dunn TB, et al. Metabolic assessment prior to total pancreatectomy and islet autotransplant: utility, limitations and potential. Am J Transplant. 2013;13(10):2664–71. This highlights the key pre-operative factors that can predict islet cell yield and potential insulin independence post-operatively. Ahmad SA, Lowy AM, Wray CJ, et al. Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. J Am Coll Surg. 2005;201(5):680–7. Naziruddin B, Matsumoto S, Noguchi H, et al. Improved pancreatic islet isolation outcome in autologous transplantation for chronic pancreatitis. Cell Transplant. 2012;21(2–3):553–8. Frezza EE. Are we closer to finding the treatment for type 2 diabetes mellitus in morbid obesity? Are the incretins the key to success? Obes Surg. 2004;14(7):999–1005. Takita M, Naziruddin B, Matsumoto S, et al. Body mass index reflects islet isolation outcome in islet autotransplantation for patients with chronic pancreatitis. Cell Transplant. 2011;20(2):313–22. Bellin MD, Balamurugan AN, Pruett TL, et al. No islets left behind: islet autotransplantation for surgery-induced diabetes. Curr Diabet Rep. 2012;12(5):580–6. Camastra S, Gastaldelli A, Mari A, et al. Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia. 2011;54(8):2093–102. Balzano G, Maffi P, Nano R, et al. Extending indications for islet autotransplantation in pancreatic surgery. Ann Surg. 2013;258(2):210–8.This paper shows potential utilization for TP-IAT in settings outside of chronic pancreatitis. Dudeja V, Beilman GJ, Vickers SM. Total pancreatectomy with islet autotransplantation in patients with malignancy: are we there yet? Ann Surg. 2013;258(2):219–20. Morgan KA, Nishimura M, Uflacker R, et al. Percutaneous transhepatic islet cell autotransplantation after pancreatectomy for chronic pancreatitis: a novel approach. HPB (Oxford). 2011;13(7):511–6. Kin T. Islet isolation for clinical transplantation. Adv Exp Med Biol. 2010;654:683–710. Balamurugan AN, Breite AG, Anazawa T, et al. Successful human islet isolation and transplantation indicating the importance of class 1 collagenase and collagen degradation activity assay. Transplantation. 2010;89(8):954–61. Anazawa T, Matsumoto S, Yonekawa Y, et al. Prediction of pancreatic tissue densities by an analytical test gradient system before purification maximizes human islet recovery for islet autotransplantation/allotransplantation. Transplantation. 2011;91(5):508–14. Balamurugan AN, Loganathan G, Bellin MD, et al. A new enzyme mixture to increase the yield and transplant rate of autologous and allogeneic human islet products. Transplantation. 2012;93(7):693–702. Rodriguez Rilo HL, Ahmad SA, D'Alessio D, et al. Total pancreatectomy and autologous islet cell transplantation as a means to treat severe chronic pancreatitis. J Gastrointest Surg. 2003;7(8):978–89. Bhayani NH, Enomoto LM, Miller JL, et al. Morbidity of total pancreatectomy with islet cell auto-transplantation compared to total pancreatectomy alone. HPB (Oxford). 2013. Kuroki T, Adachi T, Ono S, et al. Pancreatic islet autotransplantation with total pancreatectomy for chronic pancreatitis. Surg Today. 2013;43(7):715–9. Sutherland DE, Gruessner AC, Carlson AM, et al. Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes. Transplantation. 2008;86(12):1799–802. Baidal DA, Faradji RN, Messinger S, et al. Early metabolic markers of islet allograft dysfunction. Transplantation. 2009;87(5):689–97. Robertson RP, Lanz KJ, Sutherland DE, et al. Prevention of diabetes for up to 13 years by autoislet transplantation after pancreatectomy for chronic pancreatitis. Diabetes. 2001;50(1):47–50.Shows long term outcomes with insulin independence. Garcea G, Pollard CA, Illouz S, et al. Patient satisfaction and cost-effectiveness following total pancreatectomy with islet cell transplantation for chronic pancreatitis. Pancreas. 2013;42(2):322–8. Dorlon M, Owczarski S, Wang H, et al. Increase in postoperative insulin requirements does not lead to decreased quality of life after total pancreatectomy with islet cell autotransplantation for chronic pancreatitis. Am Surg. 2013;79(7):676–80. Garraway NR, Dean S, Buczkowski A, et al. Islet autotransplantation after distal pancreatectomy for pancreatic trauma. J Trauma. 2009;67(6):E187–9. Jin SM, Oh SH, Kim SK, et al. Diabetes-free survival in patients who underwent islet autotransplantation after 50% to 60% distal partial pancreatectomy for benign pancreatic tumors. Transplantation. 2013;95(11):1396–403.