Autoimmunity in Autologous Islet Transplantation.

Khawla F Ali,R Matthew Walsh,Tyler Stevens,Rita Bottino,Vicente T San Martin,Massimo Trucco,Betul Hatipoglu

doi:10.21926/obm.transplant.1803014

Abstract

Total pancreatectomy (TP) is increasingly being utilized for definitive treatment in patients with debilitating chronic pancreatitis (CP). In an effort to prevent surgical diabetes, the procedure can be performed in conjunction with transplantation of islets of Langerhans recovered from the patients’ own resected pancreas (autologous islet transplantation, AIT). Given that patients undergoing TP and AIT are traditionally assumed not to be at risk for the development of beta-cell autoimmunity, it is possible that the presence of autoimmune islet graft failure has been overlooked and underreported in this patient population. Herein, we describe two cases who underwent TP and AIT and later developed new-onset beta-cell autoimmunity (as evidenced by de novo glutamic acid decarboxylase antibody positivity), accompanied by complete insulin-dependent states. These cases emphasize the need for considering a possible autoimmune phenomenon in the workup of TP and AIT patients who manifest with unexpected and rapid deterioration in their glycemic control.

Highlights

Chronic pancreatitis (CP) is a debilitating disease that can lead to varying degrees of pancreatic endocrine and exocrine dysfunction
Total pancreatectomy (TP) is considered the therapy of last resort in patients with debilitating CP, often leading to reduced analgesic use, decreased frequency of hospital admissions for pain, and improvement in quality of life [2]. This surgical procedure can be performed with transplantation of islets of Langerhans recovered from the resected pancreas, and is intended to prevent or attenuate surgical diabetes in select patients based on pre-surgical metabolic assessments [3,4,5]
We report two additional cases of patients with CP, who had no prior history of diabetes mellitus (DM) or autoimmunity, both of whom developed new-onset beta-cell autoimmunity and subsequent failure over 12-months posttotal pancreatectomy with autologous islet transplantation (TP-AIT)

Summary

Introduction

Chronic pancreatitis (CP) is a debilitating disease that can lead to varying degrees of pancreatic endocrine and exocrine dysfunction. Total pancreatectomy (TP) is considered the therapy of last resort in patients with debilitating CP, often leading to reduced analgesic use, decreased frequency of hospital admissions for pain, and improvement in quality of life [2]. This surgical procedure can be performed with transplantation of islets of Langerhans (autologous islet transplantation, AIT) recovered from the resected pancreas, and is intended to prevent or attenuate surgical diabetes in select patients based on pre-surgical metabolic assessments [3,4,5]. We report two additional cases of patients with CP, who had no prior history of DM or autoimmunity, both of whom developed new-onset beta-cell autoimmunity and subsequent failure over 12-months posttotal pancreatectomy with autologous islet transplantation (TP-AIT)

Case Presentation

Case 2

Discussion