© 2001 SAGE Publications
Islet of Langerhans Autotransplantation: Rationale, Results, and New Developments
Autotransplantation of islets of Langerhans should be offered to patients undergoing extensive pancreatic resection for chronic pancreatitis. Results of clinical trials of islet autotransplantation (in which allorejection and recurrence of autoimmunity do not exist as causes of graft destruction) have been superior to those of allotransplantation, with insulin independence for more than 1 year achieved in 47% of recipients. The number of islets transplanted is a major indicator of outcome, since insulin independence at 1 year increases to 71% in recipients of more than 300,000 islets. Importantly, long-term pain control after extensive pancreatic resection is excellent and reaches 82% to 100%. Even in patients who achieve insulin independence, responses to intravenous glucose challenge are depressed and functional insulin secretory reserve is markedly decreased, indicating that only a reduced mass of islets engrafts. New indications for islet autotransplantation are emerging and include benign pancreatic tumors, blunt trauma, and, more controversially, malignant tumors of the pancreas.