Islet Cell Transplantation for Patients with Chronic Pancreatitis.

Abstract

The pancreas is a dual organ. The bulk (98 %) consists of the exocrine acinar tissue and the islets of Langerhans, responsible for the endocrine component constituting only about 2 % of the organ. Nevertheless, loss of this endocrine component results in severe type 3c diabetes. The blood sugar control in these patients is very labile, perhaps because of the absence of both insulin and glucagon from loss of both beta and alpha cells of the islet of Langerhans. Chronic pancreatitis typically affects the exocrine component of the gland, and the islet structure and function is preserved unless the disease is in late advanced stages. Therefore, if total or partial pancreatectomy is indicated for pain control in chronic pancreatitis, islets can beseparated from the resectedpancreas, and thentransplanted back into the patient, to prevent development of diabetes [1]. Paul Langerhans described the eponymous islets in the pancreas in 1869, before their function was even known. Minkowsky in 1892 first reported the development of diabetes, in dogs, after removal of the pancreas [2]. He also described that the subcutaneous placement of a portion of the pancreas prevented the mortality associatedwith the total pancreatectomy. Watson Williams in 1893 [2] attempted to treat diabetes, in a 15-year-old boy, by subcutaneous placement of pieces of sheep pancreas. The patient survived for a few days only, but perhaps can be considered a first attempt at a pancreatic xenograft. With the discovery of insulin from purified