Document Detail

Islet autotransplantation to preserve beta cell mass in selected patients with chronic pancreatitis and diabetes mellitus undergoing total pancreatectomy.
MedLine Citation:
PMID:  23146918     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Islet autotransplantation (IAT) is performed in nondiabetic patients with chronic pancreatitis at the time of total pancreatectomy (TP) to minimize risk of postoperative diabetes. The role of TP-IAT in patients with chronic pancreatitis and C-peptide-positive diabetes is not established. We postulate that IAT can preserve beta cell mass and thereby benefit patients with preexisting diabetes undergoing TP.
METHODS: Preoperative metabolic testing, islet isolation outcomes, and subsequent islet graft function were reviewed for 27 patients with diabetes mellitus and chronic pancreatitis undergoing TP-IAT. The relationships between the results of preoperative metabolic testing and islet isolation outcomes were explored using regression analysis.
RESULTS: Mean islet yield was 2060 (SD, 2408) islet equivalents/kg. Peak C-peptide (from mixed meal tolerance testing) was the strongest predictor of islet yield, with higher stimulated C-peptide levels associated with greater islet mass. Half of the patients who had C-peptide levels measured after transplantation demonstrated C-peptide production at a level that conveys protective benefit in type 1 diabetes (≥ 0.6 ng/mL).
CONCLUSIONS: These findings provide proof of concept that significant islet mass can be isolated in patients with chronic pancreatitis and C-peptide-positive diabetes mellitus undergoing TP-IAT. Stimulated C-peptide may be a useful marker of islet mass before transplantation in these patients.
Melena D Bellin; Gregory J Beilman; Ty B Dunn; Timothy L Pruett; Srinath Chinnakotla; Joshua J Wilhelm; Anh Ngo; David M Radosevich; Martin L Freeman; Sarah J Schwarzenberg; A N Balamurugan; Bernhard J Hering; David E R Sutherland
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pancreas     Volume:  42     ISSN:  1536-4828     ISO Abbreviation:  Pancreas     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-04-05     Completed Date:  2013-07-22     Revised Date:  2014-03-07    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  United States    
Other Details:
Languages:  eng     Pagination:  317-21     Citation Subset:  IM    
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MeSH Terms
Biological Markers / blood
Blood Glucose / metabolism
C-Peptide / blood
Chi-Square Distribution
Diabetes Mellitus, Type 1 / blood,  drug therapy,  pathology,  surgery*
Hemoglobin A, Glycosylated / metabolism
Hypoglycemic Agents / therapeutic use
Insulin-Secreting Cells / metabolism,  pathology*
Islets of Langerhans Transplantation*
Middle Aged
Pancreatitis, Chronic / surgery*
Transplantation, Autologous
Treatment Outcome
Young Adult
Grant Support
Reg. No./Substance:
0/Biological Markers; 0/Blood Glucose; 0/C-Peptide; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 0/hemoglobin A1c protein, human

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