Case Report

Is There a Benefit From Islet Autotransplantation in Patients With Type 1 Diabetes Mellitus Undergoing Total Pancreatectomy?

Mun, Kyu Shik PhD^∗,†; Nathan, Jaimie D. MD^{‡,§,∥,¶}; Lin, Tom K. MD^#,∗∗; Elder, Deborah A. MD^{∗∗,††}; Jegga, Anil G. DVM, MRes^{∗∗,‡‡}; Naren, Anjaparavanda P. PhD^{∗,∗∗,§§}; Abu-El-Haija, Maisam MD, MS^#,∗∗

Author Information

From the ^∗Division of Pulmonary Medicine, Department of Medicine, Cedars-Sinai Medical Center

^†Board of Governors Regenerative Medicine Institute, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA

^‡Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center

^§Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH

^∥Department of Abdominal Transplant and Hepatopancreatobiliary Surgery, Nationwide Children’s Hospital

^¶Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH

^#Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center

^∗∗Department of Pediatrics, University of Cincinnati College of Medicine

^††Division of Endocrinology

^‡‡Division of Biomedical Informatics

^§§Division of Pulmonary Medicine, Cystic Fibrosis Research Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Received for publication July 28, 2021; accepted March 24, 2022.

Address correspondence to: Anjaparavanda P. Naren, PhD, Division of Pulmonary Medicine, Department of Medicine, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP 9314, Los Angeles, CA 90048 (e-mail: [email protected]); Maisam Abu-El-Haija, MD, MS, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2010, Cincinnati, OH 45229 (e-mail: [email protected]).

This research was supported by the National Institutes of Health (DK080834, DK093045, P30 DK117467 to A.P.N.), CF Foundation grants to K.S.M. (MUN18F0) and A.P.N. (NAREN19R0). M.A.H. is supported by NIDDK, grant number 1K23DK118190-01.

K.S.M. performed all in vitro experiments and analyzed the data. J.D.N., T.K.L., D.A.E., A.D.J., A.P.N., and M.A.H. contributed substantially to conception of the work and to interpretation of the data. K.S.M. drafted the manuscript. J.D.N., T.K.L., D.A.E., A.D.J., A.P.N., and M.A.H. critically revised the manuscript. All authors reviewed and approved the final version of the article.

The authors declare no conflict of interest.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pancreasjournal.com).

Pancreas 51(4):p 399-403, April 2022. | DOI: 10.1097/MPA.0000000000002017

Abstract

Children with acute recurrent and chronic pancreatitis (CP) experience abdominal pain that leads to hospitalizations, opioid dependence, and poor quality of life. Total pancreatectomy with islet autotransplantation (TPIAT) is offered as a surgical option in management of debilitating pancreatitis that fails medical and endoscopic therapy to reduce or eliminate pain. Given that patients with type 1 diabetes mellitus (T1DM) lack insulin-producing β cells, the outcomes from autotransplanting islet isolates back into total pancreatectomy patients with T1DM are not fully known.

We performed TPIAT in 2 CP patients who also had a diagnosis of T1DM for at least 6 years before the operation and evaluated the clinical and laboratory outcomes before and after the operation. Postoperatively both patients' abdominal pain had significantly subsided, they were weaned off opioid medications, and they were able to return to full-time school attendance. In addition, total daily dose of insulin in 1 patient was able to be slightly reduced at 12 months post-TPIAT. We observed in vitro that residual α cells and β cells in T1DM islets were able to secrete a small amount of glucagon and insulin, respectively.