P-172 Poster of distinction

Autologous islet cell transplantation after extended/total pancreatectomy for treatment of chronic pancreatitis; the University of Virginia experience

A. Agarwal, M.A. Mallory, A.C. Fansler, P. Chhabra, B.J. Kane, H. Dorn, S.C. Kumer, T.M. Schmitt, K.L. Brayman
University of Virginia, Surgery, Transplant Division, Charlottesville, USA

Objective: To describe the safety and efficacy of autologous pancreatic islet transplants following an extended/ total pancreatectomy as a treatment for chronic pancreatitis.

Methods: Between January 2007 and March 2011, twelve patients underwent an extended pancreatectomy for definitive treatment of chronic pancreatitis. Pancreata were surgically removed by the transplant division and sent to the islet processing facility. The islets were isolated and were infused into the portal vein.

Results: Six patients underwent total pancreatectomy with six cases of near-total pancreatectomy. Mean age was 38 years (range 15-62) with a male to female ratio of 4:8. Eleven of twelve patients received and tolerated autologous islet cell infusion. One patient did not receive islet infusion secondary to infectious concerns. The mean islet equivalents were 197,500± 88100 IEQs with mean IEQ/kg of 2,746±5607 IEQ/kg. One year and three year actuarial patient survival was 100% and 91% (one case of bacteremia). There was low morbidity associated with pancreatectomy with autologous islet cell transplantation (no portal thrombosis, one pancreatic leak, one SMA injury). No patients required insulin prior to surgery. At mean follow-up of 21±18 months, five patients (45%) remain insulin independent (two patients require oral hypoglycemics). Six patients have a mean insulin requirement of 7± 6 U/day. At one month follow-up, al patients had detectable c-peptide (mean 1.8±1.5 ng/mL). Overall, all patients reported a significant decrease in pain and narcotic requirements

Conclusions: Autologous islet transplantation after extensive pancreatic resection for chronic pancreatitis is a safe and successful procedure. It offers definitive treatment of their diseased pancreas without the morbidity of brittle diabetes. Ideally, patients should be offered this therapy earlier to decrease chronic abdominal pain and preserve endogenous endocrine function.

P-172 Poster of distinction

Autologous islet cell transplantation after extended/total pancreatectomy for treatment of chronic pancreatitis; the University of Virginia experience

A. Agarwal, M.A. Mallory, A.C. Fansler, P. Chhabra, B.J. Kane, H. Dorn, S.C. Kumer, T.M. Schmitt, K.L. Brayman
University of Virginia, Surgery, Transplant Division, Charlottesville, USA

Objective: To describe the safety and efficacy of autologous pancreatic islet transplants following an extended/ total pancreatectomy as a treatment for chronic pancreatitis.

Methods: Between January 2007 and March 2011, twelve patients underwent an extended pancreatectomy for definitive treatment of chronic pancreatitis. Pancreata were surgically removed by the transplant division and sent to the islet processing facility. The islets were isolated and were infused into the portal vein.

Results: Six patients underwent total pancreatectomy with six cases of near-total pancreatectomy. Mean age was 38 years (range 15-62) with a male to female ratio of 4:8. Eleven of twelve patients received and tolerated autologous islet cell infusion. One patient did not receive islet infusion secondary to infectious concerns. The mean islet equivalents were 197,500± 88100 IEQs with mean IEQ/kg of 2,746±5607 IEQ/kg. One year and three year actuarial patient survival was 100% and 91% (one case of bacteremia). There was low morbidity associated with pancreatectomy with autologous islet cell transplantation (no portal thrombosis, one pancreatic leak, one SMA injury). No patients required insulin prior to surgery. At mean follow-up of 21±18 months, five patients (45%) remain insulin independent (two patients require oral hypoglycemics). Six patients have a mean insulin requirement of 7± 6 U/day. At one month follow-up, al patients had detectable c-peptide (mean 1.8±1.5 ng/mL). Overall, all patients reported a significant decrease in pain and narcotic requirements

Conclusions: Autologous islet transplantation after extensive pancreatic resection for chronic pancreatitis is a safe and successful procedure. It offers definitive treatment of their diseased pancreas without the morbidity of brittle diabetes. Ideally, patients should be offered this therapy earlier to decrease chronic abdominal pain and preserve endogenous endocrine function.