It has been reported in the literature that after pancreatic resection with planned islet auto-transplantation (IAT), islets isolated from alcoholic pancreatitis (AP) pancreases resulted in lower islet yields and in some cases, failed isolations (J Am Coll Surg. 2013 Apr;216:59: Should pancreatectomy with islet cell autotransplantation in patients with chronic alcoholic pancreatitis be abandoned?). Isolating islets from AP pancreases poses multiple challenges (alterations in duct structure and accumulation of fibrotic bundles) which make it difficult to obtain high islet yield. We have developed new approaches to maximize the islet yield from pancreases with AP. The modified islet isolation process includes 1) Dosing the collagenase enzyme based on severity of fibrosis instead of using the standard (brain-dead donor pancreas) one full vial approach. 2) Adequate delivery of tissue dissociation enzyme throughout the pancreas by using both intraductal and parenchymal injection methods 3) Judging the quality of distention after sectioning the pancreases and perform additional enzyme distention 4) Warm enzyme recirculation if digestion time is prolonged for >30minutes.

Etiology of chronic pancreatitis (CP) was alcoholism (n=4), and idiopathic (n=3). Islets were isolated according to the clinical transplantation protocols. AP cases were compared with idiopathic patients. The new enzyme mixture (VitaCyte CIzyme HA+ Serva Neutral Protease) was used for pancreas digestion. Islet purification was done with iodixanol density gradients. The final islet product was tested for sterility and viability. Transplant outcome was monitored by c-peptide measurements.

The average trimmed pancreas weight was 75 ± 9 grams. The average transplanted islet mass was 4,593 ± 728 IEQ/kg (nonalcoholic cases: 5,728 ± 278) and the average IEQ/gram pancreas was 4,487 ± 1,158 (nonalcoholic: 5,788 ± 1,055). The average infused tissue volume was 9.3 ± 6.2 cc. The average islet viability was >88%. Positive c-peptide secretion was monitored in all patients one month after transplantation.

Our results indicated that it was possible to obtain >4,000 IEQ/gram from AP pancreases and transplant >4500 IEQ/kg of patient body weight. Modified islet isolation approaches were effective in maximizing islet yield.

CITATION INFORMATION: Balamurugan A, Loganathan G, Tweed B, Tucker W, Mokshagundam S, Williams S, Hughes M. Isolating High Islet Mass Even from Alcoholic Pancreatitis Pancreases Intended for Clinical Islet Auto-Transplantation: Improved Strategies to Human Islet Isolation Technique. Am J Transplant. 2016;16 (suppl 3).

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