Abstract No. 168: Autologous pancreatic islet cell autotransplantation following total pancreatectomy: A modified approach

Selected patients with chronic pancreatitis may benefit from pancreatic resection. Postoperative diabetes can be ameliorated by autotransplantation of pancreatic islet cells (PIC's) harvested from the resected pancreas. Portal or mensenteric vein autotransplantation is typically performed intraoperatively and the percutaneous approach has not been used. The technique and results of our initial experience are presented. From March to September 2009, 18 patients (9 females), mean age of 39 years, with complicated chronic pancreatitis underwent pancreatectomy (17 total; 1 distal) followed by percutaneous transhepatic portal vein catheterization, under fluoroscopic guidance, using a Ring needle. After PIC's infusion, the puncture tract was embolized with gelfoam. The data was collected prospectively and from the online chart system. Isolated PIC's were transplanted early after pancreatectomy (mean 208 min., range 180-240). Average islet equivalents transplanted were 406,954 (5350 IEQ/kg), infused by gravity over a mean of 48.3 min. (range 15-65). Mean portal pressures in mmHg were: pre-infusion 9.6 (range 4-16), mid infusion 13.5 (range 7-24), peak 16.13 (12-20.85), post-infusion 15.6 (7-31). There were no deaths or early transplant related complications. One patient had a portal vein pericatheter thrombus treated with systemic heparinization. One patient had thrombocytopenia and coagulopathy. Two patients had transoperative hepatic hemorrhage, one with associated cardiac arrest successfully resuscitated. One patient had an intrahepatic arterial pseudoaneurysm due to transplant that was treated by coil embolization. Hospital length of stay was 12.4 days (range 6-21). Average of insulin administration: PO day 1 = 34.35 units (1.8-81.4), discharge day = 18.9 units (1-46) (∼45% reduction). Insulin independence was achieved in 33% of the patients at 2 months follow up (range 0.5-4). Percutaneous portal vein infusion of PIC's after pancreatectomy is safe, feasible with acceptable morbidity, and it potentially can cure or ameliorate PO diabetes. Further experience is needed to assess longer term outcomes. Risks and complications specific to islet infusion are minimal.