FAQ for Auto Islet Transplant
Pancreatectomy and Auto Islet Transplant Reduces Pain without Creating Diabetes
The American College of Surgeons (ACS) issues a press release on October 17, 2005, announcing that total pancreatectomy plus autotransplantation of islet cells reduces intractable pain - without creating diabetes - in patients with chronic pancreatitis. The press release summarized a study presented by Dr. David E.R. Sutherland at the ACS Clinical Congress in San Francisco.
In 1977, University of Minnesota surgeons performed the world's first pancreatectomy and autoislet transplant; today, as 1 of only 2 transplant centers that can perform both a pancreatectomy and autoislet transplant, we perform about two-thirds of all such procedures in the world.
Some of the patients who have undergone this procedure at the University of Minnesota Medical Center, a division of Fairview (formerly called Fairview University Medical Center) have agreed to share their stories with you regarding their life before and after their pancreatectomy and auto islet transplant. We appreciate their willingness to share their stories with you
You can also go to http://health.groups.yahoo.com/group/PancreatectomySurvivors/ and join their support group to find more indepth FAQ. Taken from their board is a Description from the group: Description This group is designed to provide emotional support and companionship to those who have undergone a Pancreatectomy, with or without an Auto-Islet transplant. It also exists to allow us to share our experiences as this surgery is relatively unchartered territory in the medical community.
We also welcome those who suffer from Pancreatitis,chronic or otherwise, and their families, who may need more information about the surgery, or just need someone who can relate to their situation. Hopefully, sharing our similar experiences will be uplifting.
Why do people want to have an auto islet transplant with their pancreatectomy?
People with chronic pancreatitis often have a total pancreatectomy to relieve pain. By having their pancreas removed, they no longer have islets to help regulate their blood sugar. Therefore, they are diabetic after the surgery.
Today, people with chronic pancreatitis have the option of having an auto-islet transplant after their pancreatectomy so that, hopefully, they will not need to take insulin shots. During this procedure, the pancreas is removed from the patient, the islets are isolated from the pancreas, and then the islets are infused by IV back into the patient through the portal vein into their liver. The auto-islet transplant has the potential to prevent diabetes or to make the diabetes milder than it would be if the patient had only a pancreatectomy.
How long will I be in the hospital following the pancreatectomy and auto islet transplant?
You should plan being in the hospital for about 2-3 weeks, depending on how fast you recover. You may be able to travel home after discharge, but some patients stay in the area for a week or so to make sure they are stable before traveling.
Will I need to take insulin shots after the surgery?
Yes, you will be on an insulin drip in the hospital. You will also learn how to manage diabetes while you are in the hospital.
How will I know that the islets are working?
As your islets start working more, you will take less insulin. It is important that you work with your local internist or family doctor to assist with the insulin adjustments after your surgery.
What are the chances that I will need insulin long-term after surgery?
If you have a pancreatectomy and auto islet transplant, there is a 50% chance that you will need insulin long-term after surgery. Keep in mind that if you have a pancreatectomy without an auto islet transplant, there is a 100% certainty that you will need insulin long-term after surgery.
How long does it usually take before the islet cells will be working well enough for me to come off the insulin?
Typically, it takes about a month for the islet cells to be working well enough that you can start to come off insulin.
Is an islet transplant a treatment or cure for pancreatic cancer?
No, islet transplants are not a treatment for cancer.
What does an islet look like?
The image to the right is an islet visualized with multi-color, laser scanning confocal immunofluorescence microscopy. It shows insulin-secreting beta cells in green, glucagon-secreting alpha cells in blue, and somatostatin-secreting delta cells in red. This photo is courtesy of T.C. Brelje and R.L. Sorenson.
Do I have to follow a special diet after an islet cell transplant?
Because of the medication they must take, transplant patients are more likely to be affected by germs that may be on or in foods. Patients should wash all fruits and vegetables thoroughly before eating and avoid raw or undercooked meat, poultry, fish, sushi, raw shellfish and raw eggs in any form (including cookie dough and eggnog). Also, some medicines may increase appetites. Therefore, it is very important for patients to follow a healthy diet to avoid gaining too much weight. The transplant team and nutritionist work with each patient to develop an individualized diet plan, taking into consideration special needs and restrictions.
Can I exercise?
Yes! It will take very little time to regain strength and endurance after a transplant, and most patients can resume normal activity within a few days. Walking and stair climbing are excellent exercises for maintaining muscle tone and strength. Patients should consider walking 5 to 10 minutes a day when they first arrive home following the transplant. Patients should abstain from strenuous exercises such as contact sports, jogging, tennis and weight lifting for at least two weeks after the operation.
Are there any restrictions I must follow?
No patient should smoke after transplant and every attempt to quit prior to the transplant is crucial to extend the patientís life and the function of the transplanted islet cells. There should be no problems resuming sexual activity, driving, traveling and returning to work or school.
What to Expect
During a pancreatectomy and auto islet transplant, surgeons remove the patient's pancreas. Then, they isolate the islets from the pancreas and infuse the islets back into the patient's portal vein in the liver. The islets lodge in the liver or spleen and start producing insulin.
About half of patients who have this procedure do not need to take insulin. Our experience indicates that if the patient has had previous surgery on the head or tail of the pancreas, they are more likely to need to take insulin shots after the pancreatectomy and auto islet transplant.
Because the patient's own islets are used, they do not need to take immunosuppressive medications after surgery.
After financial approval is obtained for surgery, how soon will surgery be scheduled?
Typically, surgery will be scheduled within 1-2 months after financial approval is received.
Is there someone I can talk to who has had this surgery?
First, you may want to read about the experiences some of University of Minnesota Medical Center patients have had before and after they had a pancreatectomy and auto-islet transplant. You can find their Stories at http://www.diabetesinstitute.org/diabinst/treatmentspancreatitis/pancreatectomy/stories.html You may also want to check out PancreatectomySurvivors wWhich can be found at http://health.groups.yahoo.com/group/PancreatectomySurvivors/. Through the PancreatectomySurviors site you will be able to find out about other people's experiences before, during and after their pancreatectomy and auto-islet transplant.
University of Minnesota Medical Center most recent results, which were presented at the 2005 annual Clinical Congress of the American College of Surgeons, indicate that a pancreatectomy and auto islet transplant can provide significant pain relief to most patients with chronic pancreatitis. In a study of 140 patients who had undergone pancreatectomy for pain associated with chronic pancreatitis, about 63% of patients had complete pain relief and 22% had partial pain relief. The remaining 15% of patients indicated that they had no change in the degree of pain after surgery.
Typically, patients who have had a pancreatectomy become diabetic after the surgery. During a pancreatectomy, the patient's pancreas is removed. The pancreas contains islets which produce insulin. Without an external source of insulin (such as insulin injections or an insulin pump), a patient who had a pancreatectomy would not survive.
However, at the University of Minnesota Medical Center, a patient can have a procedure called an autoislet transplant after their pancreatectomy. This procedure reduces the patient's need to inject themselves with insulin to manage their diabetes. During an autoislet transplant, the patient's islets are isolated from the rest of their pancreas and then transplanted back into them. Islet isolation is a very sophisticated process performed in a laboratory that meets the Good Manufacturing Practice standards set by the U.S. Food and Drug Administration. At present, the University of Minnesota Medical Center is one of only two hospitals that routinely performs pancreatectomy and auto islet transplants for patients with chronic pancreatitis.
Among 51 patients who received more than 2,000 islet equivalents per kilogram, 72% could manage their diabetes without regular injections of insulin. Of these patients, about 47% did not need insulin at all after their surgery and 25% needed only intermittent insulin treatments.
In conclusion, a total or near total pancreatectomy effectively treats pancreatitis pain in most patients who have not received relief of pain through medical management or other procedures. Auto-islet transplantation is a safe addition to extensive pancreatic resection that can prevent surgically induced diabetes, fulfilling the principle of preserving pancreatic function and relieving pain to the fullest extent possible. Patients undergoing pancreatectomy, even with an auto-islet transplant, must be willing to accept diabetes for relief of pain, but an attempt to prevent diabetes should always be made by performing an auto-islet transplant.
To obtain more information about pancreatectomy and auto islet transplantation, please contact The Transplant Center http://www.fairviewtransplant.org/ at 612-525-5115 or call 1-800-328-5465 and choose Option #1. Ask them to send you an auto islet packet.
Complete all items included in the packet and return it. Once your registration information and medical records have been received, you will be contacted for a consultation with the doctor.
Before your surgery, it is important that you have identified and met a doctor near your home who will be comfortable managing your health care after your pancreatectomy and auto islet transplant. This doctor could be an internist, a diabetologist, or a general practitioner. The doctor you choose must be willing to communicate directly with our doctors regarding your care after your surgery. We are willing to answer any questions that may arise regarding your care.
Inclusion and Exclusion Criteria
People need to meet the following criteria in order to qualify for a pancreatectomy and auto islet transplant (inclusion criteria):
1. Patients who need a total pancreatectomy, or partial pancreatectomy when a completion pancreatectomy might be required in the future.
2. Non-diabetic at the time of pancreatectomy, or mildly diabetic depending on the c-peptide results (c-peptide is indication of islet function). If the patient does not require insulin pre-pancreatectomy, we don't need c-peptide levels.
3. Benign disease of the pancreas (non cancerous)
To qualify for a pancreatectomy and auto islet transplant, people should not have the following conditions (exclusion criteria):
1. Cancer in the pancreas
I am sure there are many other questions that need to be answered and I would love feedback on this. I am working with Michael and Amy from the PancreatectomySurvivors group with these FAQ and also University of Minnesota Medical Center. If you have some questions that I haven't covered, please send them to me at firstname.lastname@example.org and I will add the Questions and and answers to this page. Thank you in advance.