*Purpose: Patients with chronic pancreatitis (CP) suffer from severe pain that greatly reduces their quality of life and often leads to long-term narcotic therapy to manage the pain. When other endoscopic or surgical treatment options have failed, patients may be referred for a total pancreatectomy and islet autotransplantation (TPIAT). In TPIAT, the diseased pancreas is removed to alleviate the pain associated with CP, and the insulin-producing islets are isolated and transplanted into the patient’s liver in an attempt to curb the development of surgical diabetes.

*Methods: We describe here the outcomes for patients undergoing TPIAT in the treatment of CP at our institution. To date, we have performed n=15 TPIAT procedures. The average age of patients undergoing TPIAT was 42 years ± 14. The most common diagnosis was idiopathic CP (66%), followed by hereditary CP (33%) and alcohol-induced CP (1%). Patients received an average islet dose of 6879.6 IEq/kg ± 5375.8 (range 957-21865 IEq/kg). The average packed cell volume was 12.2 mL ± 6.5. Portal vein pressure was monitored during infusion, with the average peak portal pressure being 19.0 cmH2O ± 6.3, and the average increase from baseline to peak pressure being 6.6 cmH2O ± 4.8.

*Results: At 1 year post-TPIAT, patients were taking an average of 10.8 units of insulin/day with n=6 patients remaining insulin independent. The average c-peptide level at 1 year post-TPIAT was 1.78 ng/mL ± 1.47, and the average 1 year hemoglobin A1c level was 6.5% ± 1.1. A high correlation was also noted between islet dose (IEq/kg) and c-peptide levels at 1 year post-TPIAT (R = 0.88). Of the n=15 patients undergoing TPIAT at our institution, n=2 patients had previously undergone a Whipple procedure as treatment for CP. Despite having already had the head of the pancreas removed, these patients had an average islet dose of 7238.5 IEq/kg, slightly higher than our patient average. The average insulin requirement for these patients at 1 year post-TPIAT was 14.5 units/day, the average c-peptide levels at 1 year were 0.45 ng/mL, and the average hemoglobin A1c levels were 6.8%.

*Conclusions: These data suggest that TPIAT is a viable treatment for patients with CP, even in patients who have already undergone a Whipple procedure.

« Back to 2019 American Transplant Congress