Technical Modifications to Improve Islet Yield from Chronic Pancreatitis Pancreas (CPP) for Islet Auto-Transplantation (IAT)

Abstract

Surgical removal of the pancreas in patients with intractable chronic pancreatitis will potentially mitigate the long standing suffering of abdominal pain and improve the quality of life. Nonetheless, the induction of iatrogenic diabetes from surgery becomes irrevocable as the insulin producing islet cells are removed. This novel process of islet isolation (both auto- and allo-) involves specific procurement and packaging of the pancreas which is then transported to a specialized clean-room where islets are isolated. The isolation involves distending the pancreas with dissociation enzymes that help in digesting the extracellular matrix and freeing the islets. The cells are then collected as pellets and purified if necessary by density gradient and later packed in the transplant bag for intra-portal infusion back to the patient. The expectant metabolic outcome following the procedure is solely dependent on the total islet mass transplanted. Despite incorporating the most standardized isolation techniques, the overall islet yields available from the diseased pancreas are still very low. Factors such as donor characteristics, pancreatic fibrosis and cellular atrophy further reduce the yield highlighting the need for effective islet isolation techniques.