June 2008

Islet Cell Transplant Relieves Chronic Pancreatitis

Hobart Harris, M.D., M.P.H
Chief of UCSF General Surgery
Vice chair of the UCSF Department of Surgery

Andrew M. Posselt, M.D., Ph.D.
Co-director of the UCSF Pancreatic Islet Transplant Program
Co-director of the UCSF Bariatric Surgery Center

To combat the debilitating back and abdominal pain caused by chronic pancreatitis, many patients take large doses of opioid analgesics, although they may be relatively ineffective and put a patient at risk of addiction.

Until recently, a total pancreatectomy was the best solution, when other treatments failed, for patients suffering from non-responsive pain. While the procedure usually relieves pain, it induces permanent diabetes, due to the removal of the blood glucose regulating islets of the pancreas. As a result, the patient must administer insulin shots or use an insulin pump for the rest of his or her life.

Now, a new procedure — a total pancreatectomy coupled with an islet autotransplant — significantly alleviates the intense pain caused by chronic pancreatitis, preserves a patient's ability to secrete insulin and cuts the risk of developing surgically induced diabetes in half. Surgeons at the UCSF Islet and Cellular Transplantation Center are among the few in the world offering this dual procedure.

Total Pancreatectomy and Islet Autotransplant

An islet autotransplant is performed at the same time as the total pancreatectomy procedure. It involves isolating a patient's islets from the removed pancreas.The islets are infused into the patient's portal vein and lodge in the liver, where they are revascularized and begin producing insulin.

The islet autotransplant may prevent diabetes from developing or result in a milder case of diabetes. There is no guarantee that diabetes won't develop because there is no way of determining the quality of a patient's islets before transplant. Patients who have a pancreatectomy with an islet autotransplant have a 50 percent chance of becoming insulin dependent for life, while patients who have a pancreatectomy alone have a 100 percent chance of becoming permanently insulin dependent.

Typically, patients spend two to three weeks in the hospital following a total pancreatectomy with islet autotransplant. During this time, patients initially receive an insulin drip to allow the transplanted islets to rest and are taught how to manage diabetes in case they develop the condition.

As islets start working, the amount of insulin is reduced. Within a month, it usually becomes clear whether the islets are working well enough for the patient to stop taking insulin or if an ongoing insulin treatment plan must be developed.

For more information, contact the Physician Referral Service at UCSF Medical Center:

Phone (888) 689-UCSF or (888) 689-8273
Email referral.center@ucsfmedctr.org

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