| Distant processing of pancreas islets for autotransplantation following total pancreatectomy. | |
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MedLine Citation:
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PMID: 10365884 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Small duct chronic pancreatitis is associated with intractable pain and failure to thrive, usually unresponsive to conventional management approaches. Total pancreatectomy is considered after failure of medical intervention. The major morbidity following total pancreatectomy is diabetes mellitus with its associated complications. This adverse outcome can be mitigated through autotransplantation of islets recovered from the pancreatectomy specimen. This approach has been limited historically owing to the absence of an on-site islet processing facility. We present the results from 5 pancreatectomized patients whose islets were prepared 1,500 miles away. METHODS: Five patients (4 women, 1 man, average age 42 years) who failed medical therapy and were not candidates for longitudinal pancreaticojejunostomy underwent total/completion pancreatectomy (4 total, 1 completion) for intractable symptoms from idiopathic small duct chronic pancreatitis. The resected pancreata were preserved in ViaSpan solution and were transferred to an islet processing laboratory by commercial airliner and returned. The dispersed pancreatic islet tissue was infused into a portal vein tributary through an operatively placed catheter after systemic heparinization. RESULTS: All 5 patients experienced complete relief from pancreatic pain; 2 had significant residual discomfort from underlying Crohn's disease. Three of the 5 patients had minimal or no insulin requirement after autotransplantation (median follow-up of 23 months); 1 patient continued with glycemic control difficulties related to Crohn's disease. One patient died 17 months following autotransplantation from an unrelated pneumonia. CONCLUSION: Total pancreatectomy with autologous islet transplantation can offer patients with idiopathic small duct chronic pancreatitis pain relief without the sequelae of diabetes mellitus and can be performed without an on-site islet processing facility. All patients undergoing total/ completion pancreatectomy should be considered candidates for this procedure. |
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Authors:
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J M Rabkin; A J Olyaei; S L Orloff; S M Geisler; D C Wahoff; B J Hering; D E Sutherland |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: American journal of surgery Volume: 177 ISSN: 0002-9610 ISO Abbreviation: Am. J. Surg. Publication Date: 1999 May |
Date Detail:
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Created Date: 1999-06-23 Completed Date: 1999-06-23 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0370473 Medline TA: Am J Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 423-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Oregon Health Sciences University and Portland Veterans Affairs Medical Center, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cell Culture Techniques / methods Cell Survival Chronic Disease Diabetes Mellitus / etiology, prevention & control Female Humans Islets of Langerhans Transplantation* Male Middle Aged Pain / therapy Pancreatectomy* Pancreatitis / surgery* Treatment Outcome |
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