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REMOTE PROCESSING OF PANCREAS CAN RESTORE NORMAL GLUCOSE HOMEOSTASIS IN AUTOLOGOUS ISLET TRANSPLANTATION AFTER TRAUMATIC WHIPPLE PANCREATECTOMY: TECHNICAL CONSIDERATIONS
Authors: Aisha Khan, Rahul M. Jindal, Craig Shriver, Stephen R. Guy, Amy E. Vertrees, Xiaojing Wang, Xiumin Xu, Joel Szust, Camillo Ricordi
Source: Cell Transplantation
Publisher: Cognizant Communication Corporation
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Abstract:
Introduction: An emergency autologous islet transplant after a traumatic Whipple operation and subsequent total pancreatectomy was performed for a 21 year old patient who was wounded with multiple abdominal gunshot wounds.Methods: After Whipple pancreatectomy, the remnant pancreas (63.5 gms), along with other damaged organs was removed by the surgeons at Walter Reed Army Medical Center (WRAMC) and shipped to Diabetes Research Institute (DRI) for islet isolation. The pancreas was preserved in UW solution for 9.25 hours prior to islet isolation. Upon arrival, the organ was visually inspected; the pancreatic head was missing, the rest of the pancreas was damaged and full of blood; the tail looked normal. A 16 G catheter was inserted into the main duct and directed towards tail of the pancreas after the dissection of main duct in the mid-body of the pancreas. The pancreas was distended with collagenase solution (Roche MTF) through the catheter. During 10-mins of intra-ductal delivery of enzyme, the gland was distended uniformly. No leakage of the solution was observed. The pancreas was transferred to a Ricordi chamber for automated mechanical and enzymatic digestion. Islets were purified using a COBE 2991 cell processor. 221,250 Islet equivalents (IEQ) of 40% purity and 90% viability were recovered during the isolation which were shipped back to WRAMC and infused by intra-portal injection into the patient.Results: Immediate islet function was demonstrated by the rapid elevation of serum C peptide — followed by insulin independence with near normal oral glucose tolerance test (OGTT) 1 and 2 months later.Conclusion: It is possible to restore near normal glucose tolerance with autologous islet transplantation after total pancreatectomy even with sub-optimal number of islets while confirming that islets processed at a remote site are suitable for transplantation.Document Type:
DOI: http://dx.doi.org/10.3727/096368911X600984
Appeared or available online: September 22, 2011
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