Total Pancreatectomy and Islet Autotransplantation: Outcome and Metabolism

Total pancreatectomy with islet autotransplantation (TPIAT) can relieve pain for patients with debilitating chronic pancreatitis refractory to medical interventions. The majority of patients report reduced pain burden and improved quality of life after surgery. For the islet autotransplant portion of the procedure, islets are isolated from the diseased pancreas and infused intraportally; suboptimal islet mass due to pancreatic fibrosis and loss of islets after infusion from innate inflammation and hypoxia are potential barriers to insulin independence. Currently, most patients demonstrate islet graft function after TPIAT, with about 30% completely insulin independent at 1-2 years. Children with hereditary pancreatitis represent a unique subgroup for TPIAT, with very young children having particularly high rates of insulin independence and pain relief. Because of challenges with the instant blood mediated inflammatory response and a dysfunctional alpha cell response to hypoglycemia, alternate transplant sites are under investigation, but, to date, intraportal infusion of islets remains the clinical standard of care.