Insulin Secretion and Glucose Tolerance Following Islet Auto-Transplantation

Insulin Secretion and Glucose Tolerance Following Islet Auto-Transplantation Chronic pancreatitis is freque Chronic pancreatitis is frequently unremitting and can lead to a syndrome of incapacitating pain. Pancreatectomy is often effective for pain relief but typically results in severe diabetes. Since 2000 thirty-five patients at our center have had total pancreatectomy with islet autotransplantation to prevent or mitigate diabetes. [beta]-cell function and glucose tolerance was evaluated in 14 of these patients before and after surgery as part of an ongoing longitudinal study. In this cohort there were 3 males and 11 females aged 36 [plusmn] 11 years (range: 16-53). The cause of pancreatitis was alcohol related in 2 of these patients and idiopathic in 12. All patients required regular opioid use for pain control. The average number of islets isolated for transplantation was 3977 [plusmn] 1782 IE/kg (range: 1352-8321). Preoperatively none of the patients were treated for diabetes. However 4 patients had impaired glucose tolerance and 5 had diabetes detected on an oral glucose tolerance test (OGT). After surgery all of the patients had a substantial reduction in pain from pancreatitis and 80% were no longer using opioids. Four patients did not require treatment for diabetes while 10 were treated with an average of 0.3 [plusmn] 0.04 units/kg (range: 0.1-0.4) of insulin. There were no hospitalizations related to diabetes. On follow up evaluation 4-6 months post-operatively there was demonstrable [beta]-cell function, but abnormal oral glucose tolerance, in all of the subjects. The mean C-peptide (CP) response to arginine was decreased by more than 60% (13 [plusmn] 6 vs 5 [plusmn] 4 ng/ml[bull]min; p [lt] 0.05), and the CP response to oral glucose by 50% (3061 [plusmn] 1845 vs 1493 [plusmn] 1137 ng/ml[bull]min; p [lt] 0.05). The CP response to arginine correlated with the number of islets transplanted (r = 0.54, p =0.055). In this cohort of patients with severe pancreatitis pancreatectomy successfully alleviated chronic pain. Islet autotransplantation partially preserved [beta]-cell function. However, this was insufficient to prevent diabetes in the majority of patients. HORACIO L. RILO, SYED A. AHMAD, L. SOMOGY, K. A. CHOE, JEFFREY B. MATTHEWS, ANDREW M. LOWY, DAVID A. D[apos]ALESSIO 154-OR Cincinnati, OH Transplantation