PANCREATIC ISLETS AUTOTRANSPLANTATION
SEVERE CHRONIC PANCREATITIS
Pancreatic islet autotransplantation benefits patients with chronic pancreatitis suffering from severe abdominal pain despite optimal medical and interventional treatments.
These patients often have a genetic mutation or a hereditary form of the disease, which progresses over the years despite medical therapy. Patients with such a high level of pain eventually require long-term narcotic use, with only limited relief.
We perform a total pancreatectomy (excision of the entire pancreas) as a “last resort” therapy, as this procedure causes an immediate onset of diabetes since the pancreas is the only source of Insulin (a hormone in the human body).
In order to improve glucose control after the surgery and prevent and/or control diabetes, we offer these patients an islet autotransplantation. Islets are retrieved from the patient’s own pancreas excised during surgery and then the islets are infused back into the patient on the same day during the same surgery. Islets flow with the blood until they settle in the liver, where they engraft and help control the patient’s blood glucose.
The goal of our research is to improve the results of the islet autotransplantation procedure, so more patients can remain not only pain free but also insulin free after the surgery.
It is an extensive, full day surgical procedure under general anesthesia.
First, the patient's pancreas is surgically removed, preserved and sent to the laboratory for islet isolation. At the same time, the gastrointestinal and biliary tract is re-constructed.
Once islets are isolated, they are infused into the portal vein in the liver and the abdomen is surgically closed. The patient is then taken to the Surgical Intensive Care Unit.
The islets transplanted are the patient's own, so no immunosuppression (anti-rejection medication) is necessary.
Excision of the entire pancreas (pancreatectomy) and new connections between liver, stomach and bowels (reconstruction of the gastrointestinal track) are performed by a hepatobiliary surgeon Dr. Jeffrey Matthews in adults, and by Dr. Mark Slidell in children (click on their pictures to get contact information)
Dr. Witkowski joins the operation to prepare the pancreas for processing, supervises the process of islet isolation and assists during the islet infusion procedure.
Dr. Ruba Azzam is a pediatrics gastroenterologists optimizing medical care in pediatric patients before and after surgery.
Pancreas and Islet Processing
in the GMP Laboratory
Pancreas and islet processing take place in a special Laboratory at the University of Chicago Hospital.
This laboratory meets all FDA requirements for cell and tissue processing for clinical applications, follows current Good Manufacture Practice (GMP) rules and regulations.
Standardized islet processing carried out in the controlled environment at the GMP facility allows to reassure the highest quality of the final islet product.
In contrast to healthy people, the pancreas from patients with years of chronic pancreatitis is usually damaged: atrophic (wasting away), severely fibrotic (scarred), so islet isolation is challenging, especially with steps of the digestion and purification.
When volume of obtained tissue is less than 20ml, islets are infused unpurified to minimize processing related cell damage and islet loss.
Heparin is added to the islet suspension and given for 2 weeks after the transplant to minimize risk of portal vein thrombosis.
Picture of isolated islets under the microscope (islet stained in red color)