Islet cell autotransplantation after pancreatectomy for chronic pancreatitis. Its limitations
C. Grodsinsky, S. Malcom, J. Goldman, S. Dienst, H. K. Oh and P. Westrick
Of 12 patients operated on for intractable pain from chronic pancreatitis,
only the three with adequate preoperative insulin reserve were selected to
undergo islet-cell replantation after subtotal pancreatectomy. Fourteen,
nine, and four months postoperatively, they require no therapy with
insulin. Since most techniques for obtaining islet cells have been
performed with normal pancreata, chronic pancreatitis was produced in ten
dogs by ligating the main and accessory pancreatic ducts. These dogs 162.6
+/- 15.8 days later underwent total pancreatectomy. The scarred pancreatic
fragments were dissociated with collagenase for 20 minutes in five dogs or
subjected to two intermittent digestions of ten minutes in the other five
dogs and were autotransplanted to the liver. One dog from each group became
normoglycemic within one week of replantation, and their percent per minute
decreases of serum glucose level were 2.72 and 3.46, respectively. Our
experimental and clinical data suggest that (1) present techniques for
dissociating fibrotic tissue are unsatisfactory and lead to a very low
yield of islet cells; (2) postoperative assessment of islet-cell function
involves complicated invasive procedures (portal and hepatic vein
cannulation) to determine accurately the source of insulin; and (3) careful
preoperative evaluation of beta-cell function is needed.
