Islet autotransplantation: past, present and future. Chapter I: chronic pancreatitis: pathogenesis, indications and treatment

SUMMARY  The most successful islet transplants have been performed in nonautoimmune diabetes patients, in an autologous setting, in conjunction with total or near-total pancreatectomy for the treatment of pancreatic or hepatobilliary conditions. The primary goals are the treatment of an underlying disease and relief of persistent pain. Islet autotransplantation is important in this setting. Following islet autotransplantation, most patients maintain good glycemic control, with ˜30–40% able to discontinue insulin therapy. Transplantation of high islet mass is associated with higher C-peptide, in-range HbA1c and insulin independence. Strategies to increase the proportion of insulin-independent patients and long-term engraftment include islet isolation, curtailing the innate immunity-associated events and beta-cell apoptosis, and alternative transplant sites. Future studies are of benefit. Chapter one reviews the pathogenesis, indications and treatment of chronic pancreatitis.