AUTO ISLET CELL TRANSPLANTATION AFTER TOTAL PANCREATECTOMY: METABOLIC

慢性胰腺炎患者通常考虑行全胰腺或近全胰腺切除术，以改善其慢性疼痛和对麻醉剂的依赖。然而，全胰腺切除会导致糖尿病和并发症。然而，胰岛分离纯化技术的发展使自体胰岛移植成为可能。自体胰岛移植可预防胰腺切除术后糖尿病及继发性并发症的发生。当胰岛注射到门静脉时，会栓塞到肝脏，并最终重新形成血管。它们还可能重新支配和改变荷尔蒙分泌的模式。由于同种异体胰岛移植尚未取得一致的成功，仅有有限数据的代谢研究很少。因此，我们建议在两年内进行20例自体胰岛移植。有7名患者将在胰腺切除后大约12个月内接受研究，这些患者接受了全胰腺切除而不进行胰岛移植。胰腺切除完成后，孤立的胰岛将通过门静脉注入肝脏。我们将研究(I)全或近全胰腺切除后自体胰岛移植在缓解疼痛、心理和心理社会功能以及麻醉药物使用方面的可行性，以及(Ii)胰岛功能和葡萄糖代谢的可行性。在印第安纳大学医学中心，我们已经建立了分离、纯化和检测人类胰岛所需的基础设施和经验。作为我们临床人类胰岛移植计划的一部分，我们已经进行了9例同种异体胰岛移植和1例自体胰岛移植。接受近全胰腺切除和自体胰岛移植的患者一直没有疼痛，并且胰岛素依赖(4个月)。目前还没有与该手术相关的死亡病例。

Patients suffering from chronic pancreatitis are often considered for total or near-total pancreatectomy to ameliorate their chronic pain and dependence on narcotic agents. Total pancreatectomy, however, leads to diabetes mellitus and complications. However, advances in the techniques of isolating and purifying pancreatic islets from pancreata have made auto-islet transplantation feasible. Auto-islet transplantation will prevent the development of post-pancreatectomy diabetes and the secondary complications. Pancreatic islets when injected into the portal vein embolize to the liver and eventually re-vascularize. They possibly also re- innervate and have an altered pattern of hormonal secretion. Because allogeneic pancreatic islet transplants have not been uniformly successful, there are few metabolic studies with only limited data. Therefore we propose to perform 20 auto-islet transplants over a period of 2 years. Seven patients will be studied approximatly 12 months post-pancreatectomy who have received total pancreatectomy without islet transplantation. Isolated islets will be injected into the liver via the portal vein after completion of the pancreatectomy. We will examine (i) the feasibility of total or near-total pancreatectomy followed by auto- islet transplantation on relief of pain, psychological and psychosocial functioning, and narcotic use and (ii) islet function and glucose metabolism. At the Indiana University Medical Center, we have established the infrastructure and experience necessary for isolating, purifying, and testing of human pancreatic islets. As part of our clinical human pancreatic islet transplant program, we have performed 9 allogeneic and 1 auto-islet transplants. The patient who received near-total pancreatectomy and auto-islet transplantation has been free of pain and is insulin independent (4 months). There has been no mortality associated with the procedure.