• Denise S Tai, Na Shen, Gregory L Szot, Andrew Posselt, Nicholas J Feduska, Andrew Habashy, Barbara Clerkin, Erin Core, Ronald W Busuttil, O Joe Hines, Howard A Reber, and Gerald S Lipshutz.
• Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
• JAMA Surg. 2015 Feb 1; 150 (2): 118-24.

ImportanceAutologous islet transplantation is an elegant and effective method for preserving euglycemia in patients undergoing near-total or total pancreatectomy for severe chronic pancreatitis. However, few centers worldwide perform this complex procedure, which requires interdisciplinary coordination and access to a sophisticated Food and Drug Administration-licensed islet-isolating facility.ObjectiveTo investigate outcomes from a single institutional case series of near-total or total pancreatectomy and autologous islet transplantation using remote islet isolation.Design, Setting, And ParticipantsRetrospective cohort study between March 1, 2007, and December 31, 2013, at tertiary academic referral centers among 9 patients (age range, 13-47 years) with chronic pancreatitis and reduced quality of life after failed medical management.InterventionsPancreas resection, followed by transport to a remote facility for islet isolation using a modified Ricordi technique, with immediate transplantation via portal vein infusion.Main Outcomes And MeasuresIslet yield, pain assessment, insulin requirement, costs, and transport time.ResultsEight of nine patients had successful islet isolation after near-total or total pancreatectomy. Four of six patients with total pancreatectomy had islet yields exceeding 5000 islet equivalents per kilogram of body weight. At 2 months after surgery, all 9 patients had significantly reduced pain or were pain free. Of these patients, 2 did not require insulin, and 1 required low doses. The mean transport cost was $16,527, and the mean transport time was 3½ hours.Conclusions And RelevancePancreatic resection with autologous islet transplantation for severe chronic pancreatitis is a safe and effective final alternative to ameliorate debilitating pain and to help prevent the development of surgical diabetes. Because many centers lack access to an islet-isolating facility, we describe our experience using a regional 2-center collaboration as a successful model to remotely isolate cells, with outcomes similar to those of larger case series.

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