Hepatic parenchymal disease such as hepatitis has been considered a relative contraindication to islet transplantation as the islets are infused into the liver. Islet transplantation is performed in patients with normal liver function and normal histology and most centers do not consider patients with hepatitis C infection (HCV). We present a case study in which a patient with treated HCV received an autologous islet transplantation following total pancreatectomy. The patient was a 60 year old female diagnosed with debilitating abdominal pain secondary to chronic pancreatitis, but with preserved islet function. The patient's medical history was significant for Hepatitis C infection. In 1999, she received standard interferon monotherapy for one year that cleared the infection. At the time of screening for total pancreatectomy and islet autotransplantation (TPIAT), the patient tested positive for hepatitis C antibody, but PCR testing was negative. Liver ultrasound showed mild steatosis. A liver biopsy showed no significant portal inflammation or fibrosis. Following a multidisciplinary discussion, we decided to proceed with TPIAT. The patient underwent a standard total pancreatectomy. Islets were isolated using previously described technique. An autologous islet dose of 6638 IEq/kg body weight was infused via the portal vein. Portal vein pressure peaked at 27 cm H2O from a basal pressure of 14 cm H2O. The islets suspension was completely infused without complication, and portal pressure measured 23 cm H20 at 10 minutes post-infusion. Liver enzymes were monitored showing a slight increase in AST to 45 U/L, which normalized prior to hospital discharge. Liver ultrasound performed 24 hrs post islet infusion showed normal flow in the portal vein. The patient recovered well and was discharged home one week post procedure. She is currently over 3 months post-transplant, and is insulin independent with a hemoglobin A1C of 5.9 %. The patient also reports a significant improvement in quality of life. In summary, despite a history of hepatitis C, this patient has demonstrated successful results in both quality of life and islet function following a TPIAT procedure. We conclude that islet autotransplant into the liver can be considered in patients with a history of hepatitis C infection without advanced fibrosis.

CITATION INFORMATION: Rajab A, Buss J, Hart P, Conwell D, Black S, Washburn K. Total Pancreatectomy and Islet Autotransplantation into the Liver of a Patient with Previous Hepatitis C Infection. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress