Abstract
Background
Islet isolation is an essential process in every human islet transplantation protocol. Intraductal enzyme delivery followed by adequate distention of the pancreas is the most critical step in islet isolation. Anomalies of the pancreatic duct system can significantly affect this process. Thus, identification and characterization of ductal patency is of paramount importance to achieve optimal islet isolation.
Aims
To investigate the frequency of duct obliteration in the human pancreas and explore donor/patient characteristics associated with specific ductal variations.
Methods
We examined ductal patency of pancreata allocated for islet allotransplantation (n = 597) and autotransplantation (n = 21) after removal of the duodenum during islet isolation procedure. Donor/patient factors were reviewed from the batch files.
Results
Among 559 deceased donor pancreata without pancreas divisum (n = 38, 6.4%), both ducts were patent in 50.1%, only ventral duct was patent in 46.7%, and only dorsal duct was patent in 3.2%. Donor age was not associated with the frequency of obliterated dorsal duct. Black race tended to have the higher frequency of patent dorsal duct. As expected, pancreas divisum was more frequent in chronic pancreatitis cases (n = 6, 28.6%). Within 7 cases of chronic pancreatitis with unknown etiology, we encountered one case of ventral duct obliteration.
Conclusions
The minor duodenal papilla and aging do not likely play an important role in the occurrence of dorsal duct obliteration. Although frequency of obliterated ventral duct was low in our population, physicians, including gastroenterologists and endoscopists, as well as islet transplantation researchers should be aware of this possibility.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kamisawa T. Clinical significance of the minor duodenal papilla and accessory pancreatic duct. J Gastroenterol. 2004;39:605–615. https://doi.org/10.1007/s00535-004-1390-1.
Kin T. Islet isolation for clinical transplantation. Adv Exp Med Biol. 2010;654:683–710. https://doi.org/10.1007/978-90-481-3271-3_30.
Ricordi C, Goldstein JS, Balamurugan AN, et al. National institutes of health-sponsored clinical islet transplantation consortium phase 3 trial: manufacture of a complex cellular product at eight processing facilities. Diabetes. 2016;65:3418–3428. https://doi.org/10.2337/db16-0234.
Kin T, Shapiro AM, Lakey JR. Pancreas divisum: a study of the cadaveric donor pancreas for islet isolation. Pancreas. 2005;30:325–327.
Kin T, Shapiro AM. Surgical aspects of human islet isolation. Islets. 2010;2:265–273.
Gonoi W, Akai H, Hagiwara K, et al. Pancreas divisum as a predisposing factor for chronic and recurrent idiopathic pancreatitis: initial in vivo survey. Gut. 2011;60:1103–1108. https://doi.org/10.1136/gut.2010.230011.
Dawson W, Langman J. An anatomical-radiological study on the pancreatic duct pattern in man. Anat Rec. 1961;139:59–68.
Suda K. Histopathology of the minor duodenal papilla. Dig Surg. 2010;27:137–139. https://doi.org/10.1159/000286920.
Ohta T, Nagakawa T, Kobayashi H, et al. Histomorphological study on the minor duodenal papilla. Gastroenterol Jpn. 1991;26:356–362.
Satterfield ST, McCarthy JH, Geenen JE, et al. Clinical experience in 82 patients with pancreas divisum: preliminary results of manometry and endoscopic therapy. Pancreas. 1988;3:248–253.
Lawrence C, Stefan AM, Howell DA. Endoscopic appearance of the minor papilla predicts findings at pancreatography. Dig Dis Sci. 2010;55:2412–2416. https://doi.org/10.1007/s10620-009-1025-8.
Stimec B, Alempijevic T, Micev M, et al. Relationship between papillary fibrosis and patency of the accessory pancreatic duct. Ann Anat. 2005;187:99–103. https://doi.org/10.1016/j.aanat.2004.08.010.
Lowenfels AB, Maisonneuve P, Grover H, et al. Racial factors and the risk of chronic pancreatitis. Am J Gastroenterol. 1999;94:790–794. https://doi.org/10.1111/j.1572-0241.1999.00952.x.
Wilcox CM, Sandhu BS, Singh V, et al. Racial differences in the clinical profile, causes, and outcome of chronic pancreatitis. Am J Gastroenterol. 2016;111:1488–1496. https://doi.org/10.1038/ajg.2016.316.
Kin T, Murdoch TB, Shapiro AM, Lakey JR. Estimation of pancreas weight from donor variables. Cell Transplant. 2006;15:181–185.
van Geenen EJ, van der Peet DL, Bhagirath P, Mulder CJ, Bruno MJ. Etiology and diagnosis of acute biliary pancreatitis. Nat Rev Gastroenterol Hepatol. 2010;7:495–502. https://doi.org/10.1038/nrgastro.2010.114.
Kamisawa T, Takuma K, Tabata T, Egawa N. Clinical implications of accessory pancreatic duct. World J Gastroenterol. 2010;16:4499–4503.
Acknowledgments
The authors thank staff of the Clinical Islet Laboratory and organ donor coordinators at the University of Alberta Hospital/Alberta Health Services. Braulio A. Marfil-Garza is currently funded by the Patronato del Instituto Nacional de Ciencias Médicas y Nutrición and the Fundación para la Salud y la Educación Salvador Zubirán A.C (FunSaEd).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Marfil-Garza, B.A., Kim, R., Shapiro, A.M.J. et al. Frequency of Obliteration of the Dorsal and Ventral Ducts of the Pancreas in Islet Transplantation. Dig Dis Sci 66, 218–223 (2021). https://doi.org/10.1007/s10620-020-06145-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-020-06145-1