Islet autotransplantation to prevent or minimize diabetes after pancreatectomy

Purpose of review Islet autotransplantation can prevent or minimize diabetes following near or total pancreatectomy for chronic pancreatitis or other lesions. Since the first case nearly 30 years ago, islet autotransplantation has been performed at more than 20 centers. This review summarizes outcomes and factors that correlate with success or failure. The main criteria for success of an islet autotransplantation per se are whether insulin-independence was maintained or insulin-need minimized, but, for those with chronic pancreatitis, as important is the degree of pain reduction, narcotic withdrawal, and quality of life improvement. Recent findings Total pancreatectomy/islet autotransplantation for chronic pancreatitis usually ameliorates pain and improves quality of life. The higher the islet yield, the more likely is the patient to be insulin-independent or metabolically stable. A prior Puestow procedure or distal pancreatectomy, or long-standing disease with severe pancreatic fibrosis, predisposes to poor islet yield. In recipients who require insulin, P cell function facilitates glycemic control. Islet autotransplantation function for more than a decade has been documented, but more studies are needed to determine durability. Summary Islet autotransplantation preserves P cell function after total pancreatectomy. Future studies comparing function of islet autografts and allografts matched for initial P cell mass may help determine the immunological and nonimmunological factors that influence long-term islet survival.