Distal pancreatectomy and islet autotransplantation for chronic pancreatitis

Eight patients with chronic pancreatitis underwent 95% pancreatectomy and islet autotransplantation. The partially purified islet material was transplanted into the liver at the time of surgery via embolization into the portal vein. Hyperglycemia requiring insulin therapy developed in all patients immediately followed surgery. Six patients subsequently became normoglycemic an average of 28 days following the transplant (range: 8-90 days). Three of these patient have remained normoglycemic on a regular diet nine, 18, and 22 months following transplant. The other three redeveloped hyperglycemia and insulin dependency three, six, and eight months after surgery. Indirect measurement of functioning islet cell mass by intravenous glucose tolerance testing preoperatively was predictive of the outcome of the transplant. All patients developed portal hypertension (14-60 cm H2O) during tissue injection into the portal vein. Portal hypertension persisted in one patient and required treatment with a mesocaval shunt. The patient subsequently died of hepatic necrosis. Postoperative catheterization in four patients, three to 12 months posttransplant, revealed that portal pressure had returned to normal. Clinically, all seven surviving patients were improved following surgery.