Total Pancreatectomy With Islet Autotransplantation for Acute Recurrent and Chronic Pancreatitis
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Purpose of review
The first total pancreatectomy and islet autotransplantation (TP-IAT) was performed for chronic pancreatitis in 1977 with the goal to ameliorate the pain and simultaneously preserve islet function. We reviewed the recent medical literature regarding indications, patient suitability, current outcomes, and challenges in TP-IAT.
Current indications for TP-IAT include intractable pain secondary to chronic pancreatitis (CP) or acute recurrent pancreatitis (ARP) with failed medical and endoscopic/surgical management. Independent studies have shown that TP-IAT is associated with elimination or significant improvement in pain control and partial or full islet graft function in the majority of patients. In single-center cost analyses, TP-IAT has been suggested to be more cost-effective than medical management of chronic pancreatitis. While initially introduced as a surgical option for adults with long-standing chronic pancreatitis, TP-IAT is now often utilized in children with chronic pancreatitis and in children and adults with intractable acute recurrent pancreatitis. The surgical procedure has evolved over time with some centers offering minimally invasive operative options, although the open approach remains the standard. Despite many advances in TP-IAT, there is a need for further research and development in disease diagnosis, patient selection, optimization of surgical technique, islet isolation and quality assessment, postoperative patient management, and establishment of uniform metrics for data collection and multicenter studies.
TP-IAT is an option for patients with otherwise intractable acute recurrent or chronic pancreatitis which presents potential for pain relief and improved quality of life, often with partial or complete diabetes remission.
KeywordsPancreatitis Diabetes TP-IAT Islet autotransplant Autoislet Chronic pancreatitis
Authored first draft (VK, MB, JJW—islet isolation); protocol/methods (TBD, GJB, SC, TLP—surgical; SJS, MF, MDB—medical); internal data (SC, GJ, MDB); critical revisions (TBD, GJB, SC, TLP, SJS, MLF); approved final draft (all)
Compliance with ethical standards
Conflict of interest
Varvara Kirchner declares that she has no potential conflicts of interest.
Ty B. Dunn declares that she has no potential conflicts of interest.
Gregory J. Beilman declares that he has no potential conflicts of interest.
Srinath Chinnakotla declares that she has no potential conflicts of interest.
Timothy L. Pruett declares that he has no potential conflicts of interest.
Joshua J. Wilhelm declares that he has no potential conflicts of interest.
Sarah J. Schwarzenberg declares that she has no potential conflicts of interest.
Martin L. Freeman declares that he has no potential conflicts of interest.
Melena D. Bellin reports grants from Merck, Medtronic, and Dompe Pharmaceuticals and personal fees from AbbVie and Ariel Precision Medicine.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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