Specialists in the Department of Surgery at The Ohio State University Medical Center have performed an innovative two-part procedure designed to alleviate chronic pancreatitis while preserving a patient’s ability to secrete insulin and avoid surgically-induced diabetes.
The procedure, a total pancreatectomy with auto-islet cell transplantation, was performed in November 2008 by Dr. Amer Rajab, assistant professor of surgery and director of pancreas and islet transplantation in the Division of Transplantation, and Dr. W. Scott Melvin, professor of surgery, chief of the Division of General and Gastrointestinal Surgery, and director of the Center for Minimally Invasive Surgery. The operation was the first of its kind at Ohio State’s Medical Center.
In the first part of the procedure, Melvin removed the patient’s pancreas to alleviate chronic pancreatitis, a painful inflammation of the pancreas that changes the organ’s structure and function. Rajab then transported the pancreas to a specialized islet isolation laboratory, where he and his team processed the pancreas to isolate the islets. The islets are the cells that produce insulin, a hormone that helps to control blood sugar levels.
In the second part of the procedure, Rajab took the islet cells to the operating room and infused them into the patient’s liver, where they would graft and mimic the function of the removed pancreas, preserving the patient’s ability to secrete insulin.
After islet cells are infused into a patient’s liver, it takes about a month for them to attach to new blood vessels and begin releasing insulin.
Rajab says the technique offers several advantages. “The procedure utilizes a patient’s own islet cells, which eliminates any threat of rejection and substantially reduces the risk of the patient developing diabetes,” he says. “Chronic pancreatitis is very painful and severely limits a person’s ability to function normally. When removing the pancreas and infusing the islet cells back into the body to reduce the risk of surgically-induced diabetes, the patient has the potential for a much better quality of life.”
Total pancreatectomy, or removal of the pancreas, is sometimes used to treat chronic pancreatitis when other treatments are unsuccessful. However, removal of all the insulin-producing cells of the pancreas induces permanent diabetes. In the past, the islet cells from a cadaveric donor were used to avoid this, but a patient had to take immunosuppressive drugs to avoid rejection of the transplanted donor cells.
Auto-islet cell transplantation is becoming more common as a treatment for pancreatitis, but the procedure is currently offered at only a few medical centers. “It’s a complicated procedure,” Rajab says. “However, it offers much promise.”
The pancreas is a gland located deep in the abdomen, between the stomach and the spine. The organ produces enzymes essential for digestion and secretes insulin and other hormones.