Current Diabetes Reports

, Volume 10, Issue 5, pp 326–331 | Cite as

Pediatric Islet Autotransplantation: Indication, Technique, and Outcome

Article

Abstract

Chronic pancreatitis is a rare disease in childhood. However, when severe, a total pancreatectomy may be the only option to relieve pain and restore quality of life. An islet autotransplant performed at the time of pancreatectomy can prevent or minimize the postsurgical diabetes that would otherwise result from pancreatectomy alone. In this procedure, the resected pancreas is mechanically disrupted and enzymatically digested to separate the islets from the surrounding exocrine tissue, and the isolated islets are infused into the portal vein and engraft in the liver. Because patients are receiving their own tissue, no immunosuppression is required. Islet autotransplant is successful in two thirds of children—these patients are insulin independent or require little insulin to maintain euglycemia. Factors associated with a more successful outcome include a younger age at transplant (<13 years), more islets transplanted, and lack of prior surgical procedures on the pancreas (partial pancreatectomy or surgical drainage procedures).

Keywords

Islet transplant Autotransplant Pancreatitis Chronic pancreatitis Hereditary pancreatitis Autoislet transplant Pancreatectomy Total pancreatectomy Islet 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Steer ML, Waxman I, Freedman S: Chronic pancreatitis. N Engl J Med 1995, 332:1482–1490.CrossRefPubMedGoogle Scholar
  2. 2.
    Ahmed SA, Wray C, Rilo HL, et al.: Chronic pancreatitis: recent advances and ongoing challenges. Curr Probl Surg 2006, 43:127–238.CrossRefPubMedGoogle Scholar
  3. 3.
    Blondet JJ, Carlson AM, Kobayashi T, et al.: The role of total pancreatectomy and islet autotransplantation for chronic pancreatitis. Surg Clin North Am 2007, 87:1477–1501.CrossRefPubMedGoogle Scholar
  4. 4.
    • Sutherland DE, Gruessner AC, Carlson AM, et al.: Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes. Transplantation 2008, 86:1799–1802. This is the largest series of islet autotransplant outcomes published, mainly in adult patients. This report details the proportion achieving insulin independence by islet yield, and also contrasts 2- to 5-year outcomes in islet autotransplant with those of allotransplant for type 1 diabetes.CrossRefPubMedGoogle Scholar
  5. 5.
    •• Bellin MD, Carlson AM, Kobayashi T, et al.: Outcome after pancreatectomy and islet autotransplantation in a pediatric population. J Pediatr Gastroenterol Nutr 2008, 47:37–44. This is the first series published detailing outcomes in children undergoing total pancreatectomy and islet autotransplant. It details pain and insulin use outcomes.CrossRefPubMedGoogle Scholar
  6. 6.
    Jie T, Hering BJ, Ansite JD, et al.: Pancreatectomy and auto-islet transplant in patients with chronic pancreatitis. ACS 2005, 201(3 Suppl):S14.Google Scholar
  7. 7.
    Lowe ME: Pancreatitis in childhood. Curr Gastroenterol Rep 2004, 6:240–246.CrossRefPubMedGoogle Scholar
  8. 8.
    Vitone LJ, Greenhalf W, Howes NR, Neoptolemos JP: Hereditary pancreatitis and secondary screening for early pancreatic cancer. Rocz Akad Med Bialymst 2005, 50:73–84.PubMedGoogle Scholar
  9. 9.
    Howes N, Lerch MM, Greenhalf W, et al.: Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol 2004, 2:252–261.CrossRefPubMedGoogle Scholar
  10. 10.
    Kandula L, Whitcomb DC, Lowe ME: Genetic issues in pediatric pancreatitis. Curr Gastroenterol Rep 2006, 8:248–253.CrossRefPubMedGoogle Scholar
  11. 11.
    Angst MS, Clark JD: Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology 2006, 104:570–587.CrossRefPubMedGoogle Scholar
  12. 12.
    Lakey JR, Warnock GL, Shapiro AM, et al.: Intraductal collagenase delivery into the human pancreas using syringe loading or controlled perfusion. Cell Transplant 1999, 8:285–292.PubMedGoogle Scholar
  13. 13.
    Ricordi C, Lacy PE, Scharp DW: Automated islet isolation from human pancreas. Diabetes 1989, 38(Suppl 1):140–142.PubMedGoogle Scholar
  14. 14.
    Lake SP, Bassett PD, Larkins A, et al.: Large-scale purification of human islets utilizing discontinuous albumin gradient on IBM 2991 cell separator. Diabetes 1989, 38(Suppl 1):143–145.PubMedGoogle Scholar
  15. 15.
    Bellin MD, Blondet JJ, Beilman GJ, et al.: Predicting islet yield in pediatric patients undergoing pancreatectomy and autoislet transplantation for chronic pancreatitis. Pediatr Diabetes 2009 Aug 25 [Epub ahead of print].Google Scholar
  16. 16.
    Rafael E, Tibell A, Ryden M, et al.: Intramuscular autotransplantation of pancreatic islets in a 7-year-old child: a 2-year follow-up. Am J Transplant 2008, 8:458–462.PubMedGoogle Scholar
  17. 17.
    Hathout E, Chan NK, Tan A, et al.: In vivo imaging demonstrates a time-line for new vessel formation in islet transplantation. Pediatr Transplant 2009, 13:892–897.CrossRefPubMedGoogle Scholar
  18. 18.
    Speier S, Nyqvist D, Cabrera O, et al.: Noninvasive in vivo imaging of pancreatic islet cell biology. Nat Med 2008, 14:574–578.CrossRefPubMedGoogle Scholar
  19. 19.
    Andersson A, Korsgren O, Jansson L: Intraportally transplanted pancreatic islets revascularized from hepatic arterial system. Diabetes 1989, 389(Suppl 1):192–195.Google Scholar
  20. 20.
    Korsgren O, Jansson L, Andersson A: Effects of hyperglycemia on function of isolated mouse pancreatic islets transplanted under kidney capsule. Diabetes 1989, 38:510–515.CrossRefPubMedGoogle Scholar
  21. 21.
    Davalli AM, Scaglia L, Zangen DH, et al.: Vulnerability of islets in the immediate posttransplantation period. dynamic changes in structure and function. Diabetes 1996, 45:1161–1167.CrossRefPubMedGoogle Scholar
  22. 22.
    Biarnes M, Montolio M, Nacher V, et al.: Beta-cell death and mass in syngeneically transplanted islets exposed to short- and long-term hyperglycemia. Diabetes 2002, 51:66–72.CrossRefPubMedGoogle Scholar
  23. 23.
    Gores PF, Najarian JS, Sutherland DER: Islet autotransplantation. In Pancreatic Islet Cell Transplantation. Edited by Ricordi C. Austin: R.G. Landers Company; 1992:291–312.Google Scholar
  24. 24.
    • Ong SL, Pollard C, Rees Y, et al.: Ultrasound changes within the liver after total pancreatectomy and intrahepatic islet cell autotransplantation. Transplantation 2008, 85:1773–1777. This article describes the typical changes in the appearance of the liver that may be seen on imaging after islet autotransplant.CrossRefPubMedGoogle Scholar
  25. 25.
    Ahmad SA, Lowy AM, Wray CJ, et al.: Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. J Am Coll Surg 2005, 201:680–687.CrossRefPubMedGoogle Scholar
  26. 26.
    Wahoff DC, Papalois BE, Najarian JS, et al.: Autologous islet transplantation to prevent diabetes after pancreatic resection. Ann Surg 1995, 222:562–575; discussion 575–579.PubMedGoogle Scholar
  27. 27.
    Behrman SW, Mulloy M: Total pancreatectomy for the treatment of chronic pancreatitis: Indications, outcomes, and recommendations. Am Surg 2006, 72:297–302.PubMedGoogle Scholar
  28. 28.
    Clayton HA, Davies JE, Pollard CA, et al.: Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: the first 40 patients at the leicester general hospital. Transplantation 2003, 76:92–98.CrossRefPubMedGoogle Scholar
  29. 29.
    Gruessner RW, Sutherland DE, Dunn DL, et al.: Transplant options for patients undergoing total pancreatectomy for chronic pancreatitis. J Am Coll Surg 2004, 198:559–567; discussion 568–569.CrossRefPubMedGoogle Scholar
  30. 30.
    Rodriguez Rilo HL, Ahmad SA, D’Alessio D, et al.: Total pancreatectomy and autologous islet cell transplantation as a means to treat severe chronic pancreatitis. J Gastrointest Surg 2003, 7:978–989.CrossRefPubMedGoogle Scholar
  31. 31.
    • Webb MA, Illouz SC, Pollard CA, et al.: Islet auto transplantation following total pancreatectomy: a long-term assessment of graft function. Pancreas 2008, 37:282–287. This article details long-term metabolic outcomes, up to 10 years after islet autotransplant, for 46 adult patients.CrossRefPubMedGoogle Scholar
  32. 32.
    Robertson RP, Lanz KJ, Sutherland DE, Kendall DM: Prevention of diabetes for up to 13 years by autoislet transplantation after pancreatectomy for chronic pancreatitis. Diabetes 2001, 50:47–50.CrossRefPubMedGoogle Scholar
  33. 33.
    Wahoff DC, Paplois BE, Najarian JS, et al.: Islet autotransplantation after total pancreatectomy in a child. J Pediatr Surg 1996, 31:132–135; discussion 135–136.CrossRefPubMedGoogle Scholar
  34. 34.
    • Kobayashi T, Manivel JC, Bellin MD, et al.: Correlation of pancreatic histopathologic findings and islet yield in children with chronic pancreatitis undergoing total pancreatectomy and islet autotransplantation Pancreas 2010, 39:57–63. This article describes the histologic findings, and their relationship to clinical status and islet yield, in children with chronic pancreatitis undergoing total pancreatectomy and islet autotransplant.CrossRefPubMedGoogle Scholar
  35. 35.
    Bellin MD, Blondet J, Beilman GJ, et al.: Islet function and glycemic control after total pancreatectomy and islet autotransplant. Presented at the 69th Scientific Sessions of the American Diabetes Association. New Orleans, LA; June 5–9, 2009.Google Scholar
  36. 36.
    Teuscher AU, Kendall DM, Smets YF, et al.: Successful islet autotransplantation in humans: functional insulin secretory reserve as an estimate of surviving islet cell mass. Diabetes 1998, 47:324–330.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Pediatrics, Schulze Diabetes InstituteUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of Surgery, Schulze Diabetes InstituteUniversity of MinnesotaMinneapolisUSA

Personalised recommendations