from an insurance group:regency:
Scientific BackgroundAutologous Islet Cell Transplant as an Adjunct to PancreatectomyAutologous islet cell transplantation as an adjunct to pancreatectomy or near total pancreatectomy has been investigated since 1977. Since then the experience has grown slowly with incremental improvements in the islet cell isolation process. Researchers at the University of Minnesota have reported the largest experience, summarizing the results in 48 patients undergoing the procedure between 1977 and 1995. (2) Of the 39 evaluable patients, 51% were insulin independent for at least one month, with the probability of sustained insulin independence dropping to 34% after two years. However, of the 18 patients who received an autotransplant with islets prepared with the most recent techniques in islet cell isolation, the long-term success rate was 55%. The most powerful predictor of insulin independence was the number of islet cells infused, which in turn is inversely related to the degree of fibrosis of the pancreas. In a small longitudinal study of 6 patients, Robertson and colleagues reported 5 patients remained free of insulin treatment for up to 13 (6.2 +/-1.7) years after intrahepatic islet autotransplantation. (3) This study also reported a correlation between the number of islets transplanted to insulin response. Unfortunately, there is currently no way to predict preoperatively the number of islet cells isolated, although patients with long-standing pancreatitis and prior surgical procedures are more likely to have a fibrotic pancreas. There have been no reports of significant morbidity or mortality associated with this procedure. (4) Although the published experience with this procedure is limited, autologous islet cell transplantation appears to significantly decrease the incidence of diabetes after total or near total pancreatectomy. In addition, this procedure is not associated with serious complications itself and is performed as an adjunct to the pancreatectomy procedure.