Expanding the indications for pancreas resection and autologous islet cell transplantation (IAT) in both adults and children

Abstract

Introduction: Pancreas resection combined with IAT is a controversial procedure with limited experience in the UK and is not funded by the NHS. We present our experience of IAT in patients with chronic pancreatitis and pancreatic trauma including the UK's first paediatric transplant. Methods: We have performed 6 pancreatic resections with IAT over 18 months. 3 patients with chronic pancreatitis (2 hereditary, 1 idiopathic) have undergone total pancreatectomy and IAT. Two patients had previous Frey procedures. 3 patients (2 adults, 1 child) sustained blunt pancreatic trauma and underwent extended left pancreatectomy combined with IAT. Complications were graded according to the Clavien-Dindo classification. Results: In the chronic pancreatitis group the islet yield was low due to fibrosis /previous drainage procedures (<50,000 IEQ). The first patient is now opiate independent and the remaining 2 patients continue on reducing doses. All have marked improvement in their quality of life. All require low dose insulin analogue therapy with in vivo C-peptide secretion. In contrast the trauma patients had a much greater islet yield (99,750–298,149 IEQ). All are insulin independent. There were no complications related to portal vein infusion and no deaths, one patient required re-laparotomy for an infected collection. Conclusions: Pancreatectomy and IAT can be used as a salvage procedure in patients who have failed all other therapy but in our opinion results would be superior if performed earlier in the course of their disease. It is also a feasible management option for complex pancreatic trauma in both adults and children.