Patients in whom 95% pancreatectomies are performed uniformly are made insulin-dependent diabetics. Survival without insulin has been described after lesser operations, but no patients are reported to have normal glucose tolerance tests after major pancreatic resections. Total or near total pancreatectomy is the surest way to relieve the pain of pancreatitis, but is rarely applied because the metabolic consequences are so severe. The cases reported here showed that endocrine function can be preserved by islet autotransplantation to the portal vein after pancreatectomy, obviating the diabetes that follows this form of therapy for patients with chronic pancreatitis. The first case illustrates that function of transplanted islet tissue in humans can be maintained for a prolonged period of time. The second case showed that intrahepatic islets survive in a remarkably good state of preservation and that free grafts of islet tissue to the intrahepatic site became neovascularized in a relatively short period of time. In the third case, plasma insulin was indetectable immediately after pancreatectomy, but did appear after islet transplantation. More importantly, this experience indicates the technical feasibility of islet transplantation in humans. Unpurified islet tissue can be transplanted into the portal vein without deterioration of liver function, and diabetes can be ameliorated. The apparent exquisite sensitivity of allogeneic islet tissue to rejection effector mechanisms is a problem that remains to be solved. The success of human islet transplantation in situations where rejection cannot occur emphasizes the need for future investigations to focus on the immunologic aspects of clinical islet allotransplantation.
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|Published - 1979