TOTAL PANCREATECTOMY WITH AUTOLOGUS ISLET CELLS TRANSPLANTATION

Chronic pancreatitis is a progressive inflammatory d isease destroying secretory pancreatic parenchyma. Total pancreatectomy and islet autotran splantation (IAT) is a viable option in selected patients in order to decrease mortality and improve hyperglycemia. Duodenum and spleen preserving total pancreatectomy and islet autotransplantation was done in 53 years old woman, with chronic pancreatitis affecting the whole pancreas. Human is let isolation was performed in the Fundeni GMP Laboratory, after informed consent has been obtaine d. Trimmed and cannulated pancreas was distended with enzymatic solution containing: 20U/g pancreas GMP grade NB1 colagenase and 0.6U/ g pancreas neutral protease in HBSS solution by inject ion of cold enzyme solution through the pancreatic duct using a perfusion Biorep system. The digestion was performed using automated method in a Ricordi chamber maintaining temperature between 32 0 C and 38 0 C. Dissociation of the pancreas and appearance of free islets was monitore d by periodically stained with 0.1% dithizone (DTZ) solution. Resulted islets were wash for two ti me in Wash Solution and were loaded in transplantation islet infusion bag. 4700 islets equ ivalent/kilogram (IEQ/kg) were infused via an inferior mesenteric vein catheter into the portal s ystem with portal pressure monitoring during infusion in ICU. The clinical follow-up at one years post IAT indicated free of insulin status. This demonstrates that total pancreatectomy with autolog us islet cells transplantation can be an appropriat e and successful therapeutically approach.