Gastroenterologie
a hepatologie

International autotransplantation of Langerhans islets into the portal tract after total pancreatectomy in a patient with chronic hereditary pancreatitis – case report and review of current literature

Daniel Bolek¹, Lenka Nosáková², Miroslav Pindura¹, Patrik Horan¹, Peter Bánovčin², Blažej Palkóci¹, Peter Girman³, Jan Kříž³, Lenka Németová³, Ivan Leontovyč⁴, Kateřina Bittenglová⁴, Denisa Osinová⁵, Juraj Miklušica¹

+ Affiliation
¹ Klinika všeobecnej, viscerálnej a transplantačnej chirurgie, JLF UK v Martine
² Interná klinika gastroenterologická JLF UK a UN Martin
³ Klinika diabetologie, IKEM, Praha
⁴ Laboratoř Langerhansových ostrůvků, IKEM, Praha
⁵ Klinika anesteziológie a intenzívnej medicíny, JLF UK v Martine

Summary

Chronic pancreatitis with repeated painful relapses is a severe multifactorial, fibroinflammatory syndrome that significantly affects the quality of life of patients, mainly in terms of pain, development of diabetes mellitus, and repeated attacks of acute pancreatitis. Autologous islet transplantation after total pancreatectomy is a potential option in selected patients with severe, recurrent painful episodes of chronic pancreatitis. In our case, we present a patient with severe recurrent chronic pancreatitis. The patient required frequent hospitalizations with repeated stenting of the pancreatic duct. After the confirmation of a genetic mutation, the members of the multidisciplinary session decided to perform a total pancreatectomy with islet autotransplantation. In this case, we present the first international islet cell autotransplantation of Langerhans islets in Slovakia after total pancreatectomy in a patient with chronic hereditary pancreatitis.

Keywords

hereditary pancreatitis, total pancreatectomy, autotransplantation of Langerhans islets

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Literature

1. Najarian JS, Sutherland DE, Baumgartner D et al. Total or near total pancreatectomy and islet autotransplantation for treatment of chronic pancreatitis. Ann Surg 1980; 192(4): 526–542. doi: 10.1097/00000658-198010000-00011.
2. Kuroki T, Adachi T, Ono S et al. Pancreatic islet autotransplantation with total pancreatectomy for chronic pancreatitis. Surg Today 2012; 43(7), 715–719. doi: 10.1007/s00595-012-0382-7.
3. Schrope, B. Total Pancreatectomy with Autologous Islet Cell Transplantation. Gastrointest Endosc Clin N Am 2018; 28(4): 605–618. doi: 10.1016/j.giec.2018.05.003.
4. Chaouch MA, Leon P, Cassese G et al. Total pancreatectomy with intraportal islet autotransplantation for pancreatic malignancies: a literature overview. Expert Opin Biol Ther 2022; 22(4): 491–497. doi: 10.1080/14712598.2022.1990261.
5. Aleotti F, Nano R, Piemonti L et al. Total pancreatectomy sequelae and quality of life: results of islet autotransplantation as a possible mitigation strategy. Updates Surg 2021; 73(4): 1237–1246. doi: 10.1007/s13304-021-01129-w.
6. Beyer G, Habtezion A, Werner J et al. Chronic pancreatitis. Lancet 2020; 396(10249): 499–512. doi: 10.1016/S0140-6736(20)31318-0.
7. Conwell DL, Banks PA, Sandhu BS et al. Validation of demographics, etiology, and risk factors for chronic pancreatitis in the USA: a report of the North American Pancreas Study (NAPS) Group. Dig Dis Sci 2017; 62: 2133–2140. doi: 10.1007/s10620-017-4621-z.
8. Beyer G, Mahajan UM, Budde C et al. Development and validation of a chronic pancreatitis prognosis score in 2 independent cohorts. Gastroenterology 2017; 153(6): 1544–1554. doi: 10.1053/j.gastro.2017.08.073.
9. Whitcomb DC, Shelton CA, Brand RE. Genetics and Genetic Testing in Pancreatic Cancer. Gastroenterology 2015; 149(5): 1252–1264. doi: 10.1053/j.gastro.2015.07.057.
10. Jones TE, Bellin MD, Yadav D et al. The histopathology of SPINK1-associated chronic pancreatitis. Pancreatology 2020; 20(8): 1648–1655. doi: 10.1016/j.pan.2020.10.030.
11. Kume K, Masamune A, Ariga H et al. Do genetic variants in the SPINK1 gene affect the level of serum PSTI? J Gastroenterol 2012; 47(11): 1267–1274. doi: 10.1007/s00535-012-0590-3.
12. Parsaik AK, Murad MH, Sathananthan A et al. Metabolic and target organ outcomes after total pancreatectomy: Mayo Clinic experience and meta-analysis of the literature. Clin Endocrinol 2010; 73(6): 723–731. doi: 10.1111/j.1365-22 65.2010.03860.x.
13. Sutherland DE, Matas AJ, Najarian JS. Pancreatic islet cell transplantation. Surg Clin North Am 1978; 58(2): 365–382. doi: 10.1016/s00 39-6109(16)41489-1.
14. Buhler L, Andereggen E, Fournier B et al. Indications for human islet transplantation: chronic pancreatitis and cystic fibrosis. Transplant Proc 1995; 27(6): 3148e9.
14. Garcea G, Weaver J, Phillips J et al. Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: a series of 85 consecutive patients. Pancreas 2009; 38(1): 1–7. doi: 10.1097/MPA.0b013e3181825c00.
15. Bellin MD, Freeman ML, Gelrud A et al. Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 2014; 14(1): 27–35. doi: 10.1016/j.pan.2013.10.009.
16. Abu-El-Haija M, Anazawa T, Beilman GJ et al. The role of total pancreatectomy with islet autotransplantation in the treatment of chronic pancreatitis: A report from the International Consensus Guidelines in chronic pancreatitis. Pancreatology 2020; 20(4): 762–771. doi: 10.1016/j.pan.2020.04.005.
17. Chinnakotla S, Bellin MD, Schwarzenberg SJ et al. Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes. Ann Surg 2014; 260(1): 56–64. doi: 10.1097/SLA. 0000000000000569.
18. Bellin MD, Freeman ML, Gelrud A et al. Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology 2014; 14(1): 27–35. doi: 10.1016/j.pan.2013.10.009.
19. Lablanche S, Borot S, Wojtusciszyn A et al. Five-Year Metabolic, Functional, and Safety Results of Patients With Type 1 Diabetes Transplanted With Allogenic Islets Within the Swiss-French GRAGIL Network. Diabetes Care 2015; 38(9): 1714–1722. doi: 10.2337/dc15-0094.