Distal Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

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Abstract
Eight patients with chronic pancreatitis underwent 95% pancreatectomy and islet autotransplantation. The partially purified islet material was transplanted into the liver at the time of surgery via embolization into the portal vein. Hyperglycemia requiring insulin therapy developed in all patients immediately following surgery. Six patients subsequently became normoglycemic an average of 28 days following the transplant (range: 8-90 days). Three of these patients remained normoglycemic on a regular diet 9, 18 and 22 mo. following transplant. The other 3 redeveloped hyperglycemia and insulin dependency 3, 6 and 8 mo. after surgery. Indirect measurement of functioning islet cell mass by i.v. glucose tolerance testing preoperatively was predictive of the outcome of the transplant. All patients developed portal hypertension (14-60 cm H2O) during tissue injection into the portal vein. Portal hypertension persisted in 1 patient and required treatment with a mesocaval shunt. The patient subsequently died of hepatic necrosis. Postoperative catheterization in 4 patients, 3-12 mo. posttransplant, revealed that portal pressure returned to normal. Clinically, all 7 surviving patients were improved following surgery.