Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis Relieves Pain and Mitigates Diabetes Development.

INTRODUCTION

By removing the intrinsic source of pain, total pancreatectomy offers patients with chronic pancreatitis a definitive surgical treatment. However, pancreatectomy results in labile diabetes. Specialized centers perform total pancreatectomy and islet autotransplantation (TP-IAT) to prevent labile diabetes and restore insulin independence after pancreatectomy.

OBJECTIVE

The objective of this retrospective study was to describe current indications and outcomes of TP-IAT performed at the University of Wisconsin (UW)-Madison, the sole center in the state offering this procedure.

METHODS

We reviewed the records of 19 TP-IAT procedures performed at our center from 2014 to 2023 for chronic and relapsing pancreatitis. All were nondiabetic and 89% required narcotics for pain. We report surgical outcomes as well as outcomes related to postoperative control of pain and diabetes, including narcotic usage, islet graft function (measured by detectable fasting serum C-peptide levels), and insulin independence.

RESULTS

The UW experience with TP-IAT demonstrates durable pain alleviation in 79% of patients. One year post-procedure, 80% of patients exhibited islet graft function; 32% remained insulin-independent.

CONCLUSIONS

In selected nondiabetic patients with chronic pancreatitis, TP-IAT is associated with durable reductions in narcotic pain medication requirements, improved quality of life measures, islet function, and mitigation of insulin dependence. Despite the advantages of TP-IAT, the procedure is still underutilized in the United States. Our data indicate that nondiabetic patients with chronic pain syndromes due to pancreatitis should be referred for possible TP-IAT to specialized centers before they lose islet function, develop significant fibrosis/calcifications, or have other major pancreatic surgical procedures.