Journal of Molecular Medicine

, Volume 77, Issue 1, pp 130–132

Pancreatic islet autotransplantation combined with total pancreatectomy for the treatment of chronic pancreatitis – the Leicester experience

Authors

  • P. R. V. Johnson
    • Department of Paediatric Surgery, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom
  • S. A. White
    • Department of Surgery, Universitiy of Leicester, UK
  • G. S. M. Robertson
    • Department of Surgery, Universitiy of Leicester, UK
  • N. Koppiker
    • Department of Diabetology, Leicester General Hospital, UK
  • A. C. Burden
    • Department of Diabetology, Leicester General Hospital, UK
  • A. R. Dennison
    • Department of Surgery, Leicester General Hospital, UK
  • N. J. M. London
    • Department of Surgery, Universitiy of Leicester, UK
Original article

DOI: 10.1007/s001090050320

Cite this article as:
Johnson, P., White, S., Robertson, G. et al. J Mol Med (1999) 77: 130. doi:10.1007/s001090050320

Abstract

Islet autotransplantation offers the potential for preventing the surgically induced diabetes that is an inevitable consequence of total pancreatectomy. This paper describes the first islet autotransplant programme in the United Kingdom and the first series in the world to use the spleen as a site for the islet graft. Over an 11 month period, 7 patients underwent total pancreatectomy for chronic pancreatitis combined with a simultaneous islet autotransplant. All 7 patients had normal glucose-tolerance levels and normal C-peptide levels pre-operatively. In 6 patients, islets were embolized into the liver via the portal vein (median transplanted volume=8.5 ml). In addition, 3 patients received islets into the splenic sinusoids via a short gastric vein (median transplanted volume=4 ml). One patient received islets into the spleen alone. One patient died of a stroke 4 weeks post transplantation. Two patients have achieved insulin independence, with a further two patients achieving ”transient” insulin independence (<1 month). The remaining 2 patients, although requiring reduced insulin doses, have not achieved insulin-independence. However, all patients have C-peptide levels within the normal range. In trying to explain these findings, split proinsulin levels were measured and found to be elevated. High levels of split proinsulin cross react with the C-peptide assay and this would explain the falsely elevated C-peptide levels. Indeed insulin levels in these patients were all below the normal range. These findings would suggest that the use of C-peptide levels as the ”gold standard” for monitoring islet autograft function, may require reappraisal.

Key words Islet autotransplantation Pancreatitis C-peptide

Copyright information

© Springer-Verlag Berlin Heidelberg 1999