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Objective, Design and Setting
Since the establishment of a cGMP islet isolation laboratory at MGH in 2007, > 100 deceased-donor pancreata have been processed and the resulting > 42 million islets have been distributed worldwide through a JDRF program promoting basic islet research. This experience also provided the foundation enabling initiation of clinical islet transplantation including 4 allogeneic islet transplants in Type-I diabetics post kidney transplant and in 2012, our first total pancreatectomy with islet auto-transplantation, the subject of this report.
Patient and Interventions
A 43-year-old female with recurrent chronic pancreatitis and persistent pain post Whipple underwent completion pancreatectomy. The pancreatic tail was preserved in cold UW and processed under cGMP conditions. The digested tissue was slowly infused over 90 minutes into the liver via the stump of the splenic vein with portal pressure monitoring.
Results
The recovered pancreas(29 grams) yielded a packed tissue volume of 10 ml with >250,000 islets of >95% viability. The postoperative course was uncomplicated with excellent glycemic control and robust early graft function with non-fasting C-peptide of 1.2 ng/ml. Four months post-operatively, the patient is insulin independent and pain free.
Conclusions
TP-IAT attempts at MGH two decades ago were unsuccessful due to the immaturity of isolation technology at that time. The current case demonstrates the feasibility of completion pancreatectomy and islet autotransplantation for chronic pancreatitis with intractable pain. The patient achieved insulin independence despite the availability of only a partial gland. These results also establish the MGH islet production and transplant program as a potential resource in the New England region for collaborative islet basic research and clinical investigation, and for partnering in islet autotransplantation in cases of total pancreatectomy.