Download Report

Islet Cell Transplant Surgery
What are islet cells?
Islet cells (pronounced "EYE-let") are actually clusters (or
groups) of cells within the pancreas that produce
hormones. It is estimated that there are approximately one
million of these clusters found in a healthy, adult pancreas,
with each cluster containing between 3,000-4,000 cells.
These islets make up only one to two percent of the entire
pancreas.
ADDITIONAL
INFORMATION
F o r mo re i nf o rmat i o n
c o nc e rni ng M U S C ' s Is l e t C e l l
Trans p l ant p ro g ram, p l e as e
e mai l Be t s y S h u f o rd , Is l e t C e l l
Trans p l ant C o o rd i nat o r, o r c al l
h e r at ( 8 4 3) 8 7 6- 04 20.
An islet contains many different types of cells that work in
harmony to help regulate the blood sugar, or
glucose, level in a person's body. Beta cells, for
example, make the hormone insulin, which
lowers the body's glucose (sugar) level.
What is islet cell
autotransplantation?
An islet cell autotransplantation, also referred to
as an autologous islet cell transplant, is the
infusion of a patient's own pancreatic islet cells
into the portal vein of the liver. The islet cells
then become lodged in blood vessels of the liver
where they become active and begin producing
insulin. Because the body recognizes these islet cells as its own, there is absolutely no rejection
of these cells by the patient's body. As a result, there will not be any need for drugs to prevent
rejection like there would be with someone who has had an organ transplanted from another
person.
The technical term for this
procedure is autologous
The technical term for this procedure is autologous
pancreatic islet cell transplantation. In this context,
'autologous' means cells that are removed from a patient's
own body. In contrast, the same procedure using islet cells
procedure is autologous
pancreatic islet cell
transplan tation … cells
that are removed from a
patient's own body.
own body. In contrast, the same procedure using islet cells
from another person is referred to as an
allotransplantation, or 'allologous', but is no longer offered
largely due to the high rate of rejection by the recipient's
body.
In select patients with debilitating pain from chronic
pancreatitis, complete removal of the pancreas can offer
significant pain relief. However, the resulting and
unavoidable severe diabetes that will occur (along with potentially life threatening episodes of
low and high blood sugars) has, in the past, precluded the recommendation of removing the
total pancreas.
With islet cell autotransplantation, however, we are able to preserve the pancreas immediately
after removal, isolate out the insulin producing islet cells, and then return them to the patient
via infusion into the liver.
The optimal patients are those with pain secondary to chronic pancreatitis having failed all
medical and other surgical management. Patients with hereditary pancreatitis are particularly
to benefit given their likelihood of progressive disease and pancreatic failure as well as their
risk for cancer.
Surgery is usually reserved for people with chronic pancreatitis who have pain that does not
respond to other treatments. A total pancreatectomy, which involves the complete removal of
the pancreas, can relieve the pain of chronic pancreatitis.
An islet cell autotransplant has the potential to prevent diabetes, or to at least make diabetes
milder and more easily managed. In fact, there is only a 30% chance that the patient will need
insulin long term after an islet cell autotransplant. In comparison, a total pancreatectomy
without the transplant results in 100% certainty that the patient will need insulin for life.
MUSC is one of very few centers in the United States offering this therapy.
What is the goal of this surgical procedure?
The goal of a total pancreatectomy with islet cell autotransplant is to improve a person's
quality of life by decreasing the level of pain (thus reducing the need for narcotic medication)
and minimizing the amount of insulin the patient will need to take to help with blood sugar
levels.
A determination of how well the transplanted cells will function will take several months, and
in some people up to a year. Some patients might not need to take insulin shots or test their
blood sugar daily, although most patients will.
What happens during the
surgery?
surgery?
Once the total pancreatectomy stage is
complete, the pancreas is immediately
preserved and taken to the cell laboratory
where the isolation of the islet cells begins. An
infusion catheter will be inserted into a vessel
leading to the patient's liver to be used for the
islet cell transplant.
Surgeons performing an islet cell
autotransplantation procedure.
Several tubes will be placed that will aid in
postoperative care:
1. a temporary drain leading out of the
abdomen will be in place to prevent fluid from accumulating in the abdomen
2. a nasogastric (NG) tube inserted through the patient's nose into the stomach will
remain until he/she is able to eat
3. a catheter placed in the patient's bladder to assist with the passing of urine
What happens immediately after the surgery?
Once the patient leaves the operating room, he/she will go to the intensive care unit (asleep
under anesthesia) where an anesthesiologist and an ICU nurse will monitor him/her until the
islet cells are ready.
When the islet cells are ready to be
transplanted, the patient will be transported
to Interventional Radiology where he/she will
continue to sleep under anesthesia. The
Interventional Radiologist will verify the
placement of the infusion catheter. The islet
cell infusion through the catheter into the
patient's liver will take about 45 minutes.
After the transplant is completed, the patient
will be transported back to the ICU and the
anesthesiologist and nurse will wake him/her
up from anesthesia.
It is important that during this time, the islet
cells be given an opportunity to rest in order
to fully graft and begin producing insulin on
their own. The patient will be on a continuous
intravenous infusion of insulin, and his/her blood glucose levels will be checked frequently.
How long will the patient be in the hospital?
The length of stay varies, but most patients remain in the hospital for 6-8 days.
Will there be scars?
A single scar will result from the incision. The patient will also have small scars from drain and
transplant sites.
What is the outlook/prognosis following this procedure?
Because the islets come from the patient's own pancreas, there is no chance of tissue rejection.
However, it may take some time for the islet cells to produce enough insulin to maintain
normal blood glucose levels. We will teach the patient to give himself/herself insulin injections
to meet that need. A certified diabetic educator will give the patient detailed instructions
regarding these injections along with a glucometer and testing kit before he/she is discharged
from the hospital.
What about pain control after surgery?
The anesthesiologist will manage the patient's pain after surgery using epidural medication
along with IV medication. Once the patient is transferred to the inpatient floor, he/she will
transition to oral medication for pain management. During the outpatient visits, we will work
with the patient and the Behavioral Medicine team to slowly adjust and lower the levels of pain
medication.
What should a patient watch out for after discharge?
The patient should contact their doctor if any of the following symptoms appear:
Inability to eat or drink for 24 hours due to any reason
Fever
Redness, swelling or warmth around the incision
Drainage from the incision
Symptoms of high or low blood sugar as described in the Islet Cell Transplant Guide
for Patients
Any unusual symptom that concerns the patient should be reported to his/her
doctor.
What follow-up appointments will be needed?
A two-week follow-up appointment with the surgeon, diabetes management team, and
behavioral medicine team will be made before the patient leaves the hospital. Appointments are
monthly as needed and then at six months and one year.
When can a patient expect to resume normal activities?
Although this varies among patients depending on pain tolerance, coping mechanisms and
support systems, the patient will be encouraged to return to normal activities —things such as
showering, driving, walking up stairs, light lifting, returning to work, etc.— as soon as he/she
feels comfortable. We advise that the patient avoid heavy lifting or straining for six to eight
weeks after surgery. If the patient is taking narcotic medications for pain, he/she should not
drive.
It is very important that the patient adhere to the recommended diet in order to
continue to manage blood sugar and pancreatic insufficiency.
Additional Information
For more information concerning MUSC's Islet Cell Transplant program, please email Betsy
Shuford, Islet Cell Transplant Coordinator, or call her at (843) 876-0420.
25 Courtenay Dr., Ashley River Tower, Charleston, S.C. 29425
Reception: (843) 792-6999 • Scheduling: (843) 792-6982 • Clinical Trials: (843) 876-4303
© 2015 MUSC Digestive Disease Center. All rights reserved.