Human Pancreatic Cell Autotransplantation Following Total Pancreatectomy

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Abstract
During total pancreaticoduodenectomy for chronic pancreatitis, 4 patients received an intraportal pancreatic mixed-cell autograft prepared by collagenase digestion. The technique of this autotransplantation procedure was successfully developed using a normal canine pancreas, but has proved difficult to apply in the human chronic pancreatitis model. Our 4 patients became insulin-dependent, with proof of intrahepatic insulin production in only 1 patient. Three factors have contributed to the lack of graft success: the preoperative endocrine status, systemic hypotension and portal hypertension secondary to graft infusion, and difficulty applying the successful technique in a normal dog pancreas to an extensively scarred human pancreas. The preoperative insulin response during a glucose tolerance test was blunted or delayed in the 3 patients tested. An immediate decrease in blood pressure and rise in portal pressure occurred in every patient and prevented infusion of the entire graft (30-50%) in 3 patients. The patient with the most compromised insulin status was the only patient able to receive the entire graft. Further refinements in technique apparently are necessary to prevent the vascular reaction and allow infusion of the entire graft. Normal islet cell function is necessary before a successful graft can be expected.