Keywords
islet auto-transplantation
pancreatectomy
chronic pancreatitis
diabetes
quality of life
pancreatectomy
chronic pancreatitis
diabetes
quality of life
How to Cite
Dhigoi, N., Muco, E., Jupe, F., Telo, S., Blloshmi, A., & Dogjani, A. (2025). Total Pancreatectomy with Islet Auto-transplantation in Chronic Pancreatitis is the Call of our Time. Albanian Journal of Trauma and Emergency Surgery, 9(2), 1844 - 1851. https://doi.org/10.32391/ajtes.v9i2.469
Abstract
Introduction: Total pancreatectomy with islet auto-transplantation is a realistic therapeutic choice and an advanced surgical operation for individuals with chronic pancreatitis.
The primary purpose of total pancreatectomy with islet auto-transplantation is to alleviate the debilitating pain caused by chronic pancreatitis and thereby significantly improve the quality of life of patients with chronic pancreatitis. Although the permanent loss of the function of the pancreatic endocrine occurs due to total pancreatectomy, it may be substituted by autologous transplantation of islets.
Patients receiving total pancreatectomy and Islet Transplantation may be less dependent on insulin than patients receiving total pancreatectomy. This process, although not without some difficulties, has consistently demonstrated promising results in reducing pain, improving glycemic control, mitigating diabetic complications, and enhancing the overall quality of life in patients with chronic pancreatitis. In this article, we review the global experience with Total pancreatectomy with islet auto-transplantation and examine the prospects for its implementation in the Albanian health system.
They can alleviate the burden of chronic pancreatitis, improve patients' prognosis, and enhance the country's healthcare system capacity. However, the introduction will also necessitate a strategic transformation of infrastructure, training, and health policy, which is discussed below.
Conclusions: Total pancreatectomy with islet auto-transplantation is a novel, effective treatment option for patients with recurrent acute pancreatitis and those with chronic pancreatitis. Its implementation in Albania, while promising, necessitates strategic reforms in infrastructure, training, and health policy. However, if constructed as a secondary project with the aim of institutional support, these reforms can significantly increase the quality of care for patients with chronic pancreatitis in our country.
References
1. Majumder, S., & Chari, S. T. (2016). Chronic pancreatitis. Lancet (London, England), 387(10031), 1957–1966. https://doi.org/10.1016/S0140-6736(16)00097-0
2. Gardner, T. B., Adler, D. G., Forsmark, C. E., et al. (2020). ACG Clinical Guideline: Chronic Pancreatitis. The American journal of gastroenterology, 115(3), 322–339. https://doi.org/10.14309/ajg.0000000000000535
3. Vege, S. S., & Chari, S. T. (2022). Chronic Pancreatitis. The New England journal of medicine, 386(9), 869–878. https://doi.org/10.1056/NEJMcp1809396
4. Olesen, S. S., Juel, J., Nielsen, A. K., et al. (2014). Pain severity reduces life quality in chronic pancreatitis: Implications for design of future outcome trials. Pancreatology: official journal of the International Association of Pancreatology (IAP) ... [et al.], 14(6), 497–502. https://doi.org/10.1016/j.pan.2014.09.009
5. Shimizu, K., Ito, T., Irisawa, A., et al. (2022). Evidence-based clinical practice guidelines for chronic pancreatitis 2021. Journal of gastroenterology, 57(10), 709–724. https://doi.org/10.1007/s00535-022-01911-6
6. Kretschmer, G. J., Sutherland, D. E., Matas, A. J., et al. (1977). Autotransplantation of pancreatic islets without separation of exocrine and endocrine tissue in totally pancreatectomized dogs. Surgery, 82(1), 74–81.
7. Kretschmer, G. J., Sutherland, D. R., Matas, A. J., et al. (1978). Autotransplantation of pancreatic fragments to the portal vein and spleen of totally pancreatectomized dogs: a comparative evaluation. Annals of surgery, 187(1), 79–86. https://doi.org/10.1097/00000658-197801000-00015
8. Jahansouz, C., Jahansouz, C., Kumer, S. C., & Brayman, K. L. (2011). Evolution of β-Cell Replacement Therapy in Diabetes Mellitus: Islet Cell Transplantation. Journal of transplantation, 2011, 247959. https://doi.org/10.1155/2011/247959
9. Pyzdrowski, K. L., Kendall, D. M., Halter, J. B., et al. (1992). Preserved insulin secretion and insulin independence in recipients of islet autografts. The New England journal of medicine, 327(4), 220–226. https://doi.org/10.1056/NEJM199207233270402
10. Cassar, N., Cromwell, P., Duggan, S., et al. (2024). Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials. Digestive surgery, 41(1), 1–11. https://doi.org/10.1159/000535588
11. Cahen, D. L., Gouma, D. J., Nio, Y., et al. (2007). Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. The New England journal of medicine, 356(7), 676–684. https://doi.org/10.1056/NEJMoa060610
12. Cahen, D. L., Gouma, D. J., Laramée, P., et al. (2011). Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology, 141(5), 1690–1695. https://doi.org/10.1053/j.gastro.2011.07.049
13. Ammann R. W. (2006). Diagnosis and management of chronic pancreatitis: current knowledge. Swiss medical weekly, 136(11-12), 166–174. https://doi.org/10.4414/smw.2006.11182
14. Bellin, M. D., Gelrud, A., Arreaza-Rubin, G., Dunn, T. B., et al. (2014). Total pancreatectomy with islet autotransplantation: summary of a National Institute of Diabetes and Digestive and Kidney diseases workshop. Pancreas, 43(8), 1163–1171. https://doi.org/10.1097/MPA.0000000000000236
15. Muniraj, T., Aslanian, H. R., Farrell, J., & Jamidar, P. A. (2015). Chronic pancreatitis, a comprehensive review and update. Part II: Diagnosis, complications, and management. Disease-a-month: DM, 61(1), 5–37. https://doi.org/10.1016/j.disamonth.2014.12.003
16. Sutherland, D. E., Radosevich, D. M., Bellin, M. D., et al. (2012). Total pancreatectomy and islet autotransplantation for chronic pancreatitis. Journal of the American College of Surgeons, 214(4), 409–426. https://doi.org/10.1016/j.jamcollsurg.2011.12.040
17. Blondet, J. J., Carlson, A. M., Kobayashi, T., et al. (2007). The role of total pancreatectomy and islet autotransplantation for chronic pancreatitis. The Surgical clinics of North America, 87(6), 1477–x. https://doi.org/10.1016/j.suc.2007.08.014
18. Bellin, M. D., Sutherland, D. E., & Robertson, R. P. (2012). Pancreatectomy and autologous islet transplantation for painful chronic pancreatitis: indications and outcomes. Hospital practice (1995), 40(3), 80–87. https://doi.org/10.3810/hp.2012.08.992
19. Catalano, M. F., Sahai, A., Levy, M., et al. (2009). EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointestinal endoscopy, 69(7), 1251–1261. https://doi.org/10.1016/j.gie.2008.07.043
20. Chinnakotla, S., Beilman, G. J., Dunn, T. B., et al. (2015). Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases. Annals of surgery, 262(4), 610–622. https://doi.org/10.1097/SLA.0000000000001453
21. Angst, M. S., & Clark, J. D. (2006). Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology, 104(3), 570–587. https://doi.org/10.1097/00000542-200603000-00025
22. Bellin, M. D., Freeman, M. L., Gelrud, A., et al. (2014). Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 14(1), 27–35. https://doi.org/10.1016/j.pan.2013.10.009
23. Bramis, K., Gordon-Weeks, A. N., Friend, P. J., et al. (2012). Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis. The British journal of surgery, 99(6), 761–766. https://doi.org/10.1002/bjs.8713
24. Walsh, R. M., Saavedra, J. R., Lentz, G., et al. (2012). Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(8), 1469–1477. https://doi.org/10.1007/s11605-012-1914-6
25. Ricordi, C., Lacy, P. E., & Scharp, D. W. (1989). Automated islet isolation from human pancreas. Diabetes, 38 Suppl 1, 140–142. https://doi.org/10.2337/diab.38.1.s140
26. Witkowski, P., Savari, O., & Matthews, J. B. (2014). Islet autotransplantation and total pancreatectomy. Advances in surgery, 48, 223–233. https://doi.org/10.1016/j.yasu.2014.05.006
27. Bellin, M. D., Freeman, M. L., Schwarzenberg, S. J., et al. (2011). Quality of life improves for pediatric patients after total pancreatectomy and islet autotransplant for chronic pancreatitis. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 9(9), 793–799. https://doi.org/10.1016/j.cgh.2011.04.024
28. Chinnakotla, S., Beilman, G. J., Vock, D., et al. (2022). Intraportal Islet Autotransplantation Independently Improves Quality of Life After Total Pancreatectomy in Patients With Chronic Refractory Pancreatitis. Annals of surgery, 276(3), 441–449. https://doi.org/10.1097/SLA.0000000000005553
29. Bellin, M. D., Beilman, G. J., Sutherland, D. E., et al. (2019). How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis? Journal of the American College of Surgeons, 228(4), 329–339. https://doi.org/10.1016/j.jamcollsurg.2018.12.019
30. Shahbazov, R., Naziruddin, B., Salam, O., et al. (2020). The impact of surgical complications on the outcome of total pancreatectomy with islet autotransplantation. American journal of surgery, 219(1), 99–105. https://doi.org/10.1016/j.amjsurg.2019.04.007
31. Butterfield, J. T., Vakayil, V. R., Joppru, K., et al. (2021). Factors Associated with Morbidity Following Total Pancreatectomy and Islet Autotransplantation: A NSQIP Analysis. Transplantation proceedings, 53(2), 705–711. https://doi.org/10.1016/j.transproceed.2020.11.013
32. Berger, M. G., Majumder, K., Hodges, J. S., et al. (2016). Microbial contamination of transplant solutions during pancreatic islet autotransplants is not associated with clinical infection in a pediatric population. Pancreatology: official journal of the International Association of Pancreatology (IAP) ... [et al.], 16(4), 555–562. https://doi.org/10.1016/j.pan.2016.03.019
33. Gołębiewska, J. E., Bachul, P. J., Fillman, N., et al. (2019). Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 23(11), 2201–2210. https://doi.org/10.1007/s11605-019-04118-y
34. Robbins, A. J., Skube, M. E., Bellin, M. D., et al. (2019). Portal Vein Thrombosis After Total Pancreatectomy and Islet Autotransplant: Prophylaxis and Graft Impact. Pancreas, 48(10), 1329–1333. https://doi.org/10.1097/MPA.0000000000001421
35. Kawahara, T., Kin, T., Kashkoush, S., et al. (2011). Portal vein thrombosis is a potentially preventable complication in clinical islet transplantation. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 11(12), 2700–2707. https://doi.org/10.1111/j.1600-6143.2011.03717.x
2. Gardner, T. B., Adler, D. G., Forsmark, C. E., et al. (2020). ACG Clinical Guideline: Chronic Pancreatitis. The American journal of gastroenterology, 115(3), 322–339. https://doi.org/10.14309/ajg.0000000000000535
3. Vege, S. S., & Chari, S. T. (2022). Chronic Pancreatitis. The New England journal of medicine, 386(9), 869–878. https://doi.org/10.1056/NEJMcp1809396
4. Olesen, S. S., Juel, J., Nielsen, A. K., et al. (2014). Pain severity reduces life quality in chronic pancreatitis: Implications for design of future outcome trials. Pancreatology: official journal of the International Association of Pancreatology (IAP) ... [et al.], 14(6), 497–502. https://doi.org/10.1016/j.pan.2014.09.009
5. Shimizu, K., Ito, T., Irisawa, A., et al. (2022). Evidence-based clinical practice guidelines for chronic pancreatitis 2021. Journal of gastroenterology, 57(10), 709–724. https://doi.org/10.1007/s00535-022-01911-6
6. Kretschmer, G. J., Sutherland, D. E., Matas, A. J., et al. (1977). Autotransplantation of pancreatic islets without separation of exocrine and endocrine tissue in totally pancreatectomized dogs. Surgery, 82(1), 74–81.
7. Kretschmer, G. J., Sutherland, D. R., Matas, A. J., et al. (1978). Autotransplantation of pancreatic fragments to the portal vein and spleen of totally pancreatectomized dogs: a comparative evaluation. Annals of surgery, 187(1), 79–86. https://doi.org/10.1097/00000658-197801000-00015
8. Jahansouz, C., Jahansouz, C., Kumer, S. C., & Brayman, K. L. (2011). Evolution of β-Cell Replacement Therapy in Diabetes Mellitus: Islet Cell Transplantation. Journal of transplantation, 2011, 247959. https://doi.org/10.1155/2011/247959
9. Pyzdrowski, K. L., Kendall, D. M., Halter, J. B., et al. (1992). Preserved insulin secretion and insulin independence in recipients of islet autografts. The New England journal of medicine, 327(4), 220–226. https://doi.org/10.1056/NEJM199207233270402
10. Cassar, N., Cromwell, P., Duggan, S., et al. (2024). Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials. Digestive surgery, 41(1), 1–11. https://doi.org/10.1159/000535588
11. Cahen, D. L., Gouma, D. J., Nio, Y., et al. (2007). Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. The New England journal of medicine, 356(7), 676–684. https://doi.org/10.1056/NEJMoa060610
12. Cahen, D. L., Gouma, D. J., Laramée, P., et al. (2011). Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology, 141(5), 1690–1695. https://doi.org/10.1053/j.gastro.2011.07.049
13. Ammann R. W. (2006). Diagnosis and management of chronic pancreatitis: current knowledge. Swiss medical weekly, 136(11-12), 166–174. https://doi.org/10.4414/smw.2006.11182
14. Bellin, M. D., Gelrud, A., Arreaza-Rubin, G., Dunn, T. B., et al. (2014). Total pancreatectomy with islet autotransplantation: summary of a National Institute of Diabetes and Digestive and Kidney diseases workshop. Pancreas, 43(8), 1163–1171. https://doi.org/10.1097/MPA.0000000000000236
15. Muniraj, T., Aslanian, H. R., Farrell, J., & Jamidar, P. A. (2015). Chronic pancreatitis, a comprehensive review and update. Part II: Diagnosis, complications, and management. Disease-a-month: DM, 61(1), 5–37. https://doi.org/10.1016/j.disamonth.2014.12.003
16. Sutherland, D. E., Radosevich, D. M., Bellin, M. D., et al. (2012). Total pancreatectomy and islet autotransplantation for chronic pancreatitis. Journal of the American College of Surgeons, 214(4), 409–426. https://doi.org/10.1016/j.jamcollsurg.2011.12.040
17. Blondet, J. J., Carlson, A. M., Kobayashi, T., et al. (2007). The role of total pancreatectomy and islet autotransplantation for chronic pancreatitis. The Surgical clinics of North America, 87(6), 1477–x. https://doi.org/10.1016/j.suc.2007.08.014
18. Bellin, M. D., Sutherland, D. E., & Robertson, R. P. (2012). Pancreatectomy and autologous islet transplantation for painful chronic pancreatitis: indications and outcomes. Hospital practice (1995), 40(3), 80–87. https://doi.org/10.3810/hp.2012.08.992
19. Catalano, M. F., Sahai, A., Levy, M., et al. (2009). EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointestinal endoscopy, 69(7), 1251–1261. https://doi.org/10.1016/j.gie.2008.07.043
20. Chinnakotla, S., Beilman, G. J., Dunn, T. B., et al. (2015). Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases. Annals of surgery, 262(4), 610–622. https://doi.org/10.1097/SLA.0000000000001453
21. Angst, M. S., & Clark, J. D. (2006). Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology, 104(3), 570–587. https://doi.org/10.1097/00000542-200603000-00025
22. Bellin, M. D., Freeman, M. L., Gelrud, A., et al. (2014). Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 14(1), 27–35. https://doi.org/10.1016/j.pan.2013.10.009
23. Bramis, K., Gordon-Weeks, A. N., Friend, P. J., et al. (2012). Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis. The British journal of surgery, 99(6), 761–766. https://doi.org/10.1002/bjs.8713
24. Walsh, R. M., Saavedra, J. R., Lentz, G., et al. (2012). Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(8), 1469–1477. https://doi.org/10.1007/s11605-012-1914-6
25. Ricordi, C., Lacy, P. E., & Scharp, D. W. (1989). Automated islet isolation from human pancreas. Diabetes, 38 Suppl 1, 140–142. https://doi.org/10.2337/diab.38.1.s140
26. Witkowski, P., Savari, O., & Matthews, J. B. (2014). Islet autotransplantation and total pancreatectomy. Advances in surgery, 48, 223–233. https://doi.org/10.1016/j.yasu.2014.05.006
27. Bellin, M. D., Freeman, M. L., Schwarzenberg, S. J., et al. (2011). Quality of life improves for pediatric patients after total pancreatectomy and islet autotransplant for chronic pancreatitis. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 9(9), 793–799. https://doi.org/10.1016/j.cgh.2011.04.024
28. Chinnakotla, S., Beilman, G. J., Vock, D., et al. (2022). Intraportal Islet Autotransplantation Independently Improves Quality of Life After Total Pancreatectomy in Patients With Chronic Refractory Pancreatitis. Annals of surgery, 276(3), 441–449. https://doi.org/10.1097/SLA.0000000000005553
29. Bellin, M. D., Beilman, G. J., Sutherland, D. E., et al. (2019). How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis? Journal of the American College of Surgeons, 228(4), 329–339. https://doi.org/10.1016/j.jamcollsurg.2018.12.019
30. Shahbazov, R., Naziruddin, B., Salam, O., et al. (2020). The impact of surgical complications on the outcome of total pancreatectomy with islet autotransplantation. American journal of surgery, 219(1), 99–105. https://doi.org/10.1016/j.amjsurg.2019.04.007
31. Butterfield, J. T., Vakayil, V. R., Joppru, K., et al. (2021). Factors Associated with Morbidity Following Total Pancreatectomy and Islet Autotransplantation: A NSQIP Analysis. Transplantation proceedings, 53(2), 705–711. https://doi.org/10.1016/j.transproceed.2020.11.013
32. Berger, M. G., Majumder, K., Hodges, J. S., et al. (2016). Microbial contamination of transplant solutions during pancreatic islet autotransplants is not associated with clinical infection in a pediatric population. Pancreatology: official journal of the International Association of Pancreatology (IAP) ... [et al.], 16(4), 555–562. https://doi.org/10.1016/j.pan.2016.03.019
33. Gołębiewska, J. E., Bachul, P. J., Fillman, N., et al. (2019). Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 23(11), 2201–2210. https://doi.org/10.1007/s11605-019-04118-y
34. Robbins, A. J., Skube, M. E., Bellin, M. D., et al. (2019). Portal Vein Thrombosis After Total Pancreatectomy and Islet Autotransplant: Prophylaxis and Graft Impact. Pancreas, 48(10), 1329–1333. https://doi.org/10.1097/MPA.0000000000001421
35. Kawahara, T., Kin, T., Kashkoush, S., et al. (2011). Portal vein thrombosis is a potentially preventable complication in clinical islet transplantation. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 11(12), 2700–2707. https://doi.org/10.1111/j.1600-6143.2011.03717.x
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