Total Pancreatectomy and Islet Cell Autotransplantation: Outcomes, Controversies and New Techniques

  • Michal Radomski Division of Surgical Oncology, University of Pittsburgh. Pittsburgh, Pennsylvania, USA
  • Amer H Zureikat Division of Surgical Oncology, University of Pittsburgh. Pittsburgh, Pennsylvania, USA
Keywords: Islets of Langerhans Transplantation, Pancreatectomy, Pancreatitis, Chronic


Chronic pancreatitis is a challenging disease; the constellation of chronic abdominal pain and metabolic derangements present unique difficulties to the treating physician. Initial treatment revolves around lifestyle modification, pain control, and management of exocrine insufficiency. In refractory cases, total pancreatectomy with islet cell auto transplantation (TP-IAT) is an option for patients with diffuse disease not amenable to subtotal pancreatectomy or a decompressive (drainage) operation. This procedure aspires to alleviate pain and avoid surgically induced brittle diabetes, a morbid complication of total pancreatectomy alone. Herein, we review the indications, optimal timing, surgical outcomes and controversies for TP-IAT, focusing on recently published reports.

Image: University of Pittsburgh logo. Pittsburgh, Pennsylvania, USA


Download data is not yet available.


Cote GA, Yadav D, Slivka A, et al. Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2011; 9: 266-73; quiz e27. [PMID: 21029787]

Frulloni L, Gabbrielli A, Pezzilli R, et al. Chronic pancreatitis: report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2009; 41: 311-7. [PMID: 19097829]

Ong SL, Gravante G, Pollard CA, Webb MA, Illouz S, Dennison AR. Total pancreatectomy with islet autotransplantation: an overview. HPB : the official journal of the International Hepato Pancreato Biliary Association 2009; 11: 613-21. [PMC: 2799613]

Dufour MC, Adamson MD. The epidemiology of alcohol-induced pancreatitis. Pancreas 2003; 27: 286-90. [PMID: 14576488]

Brock C, Nielsen LM, Lelic D, Drewes AM. Pathophysiology of chronic pancreatitis. World journal of gastroenterology : WJG 2013; 19: 7231-40. [PMC: 3831204]

Vonlaufen A, Wilson JS, Pirola RC, Apte MV. Role of alcohol metabolism in chronic pancreatitis. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism 2007; 30: 48-54. [PMID: 17718401]

LaRusch J, Solomon S, Whitcomb DC. Pancreatitis Overview. In: Pagon RA, Adam MP, Ardinger HH, et al., eds. GeneReviews(R). Seattle (WA)2014. [NBK: 190101]

Rebours V, Boutron-Ruault MC, Schnee M, et al. The natural history of hereditary pancreatitis: a national series. Gut 2009; 58: 97-103. [PMID: 18755888]

Applebaum-Shapiro SE, Finch R, Pfutzer RH, et al. Hereditary pancreatitis in North America: the Pittsburgh-Midwest Multi-Center Pancreatic Study Group Study. Pancreatology : official journal of the International Association of Pancreatology 2001; 1: 439-43. [PMID: 12120221]

Fink EN, Kant JA, Whitcomb DC. Genetic counseling for nonsyndromic pancreatitis. Gastroenterology clinics of North America 2007; 36: 325-33, ix. [PMID: 17533082]

Pfutzer RH, Barmada MM, Brunskill AP, et al. SPINK1/PSTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology 2000; 119: 615-23. [PMID: 10982753]

Mounzer R, Whitcomb DC. Genetics of acute and chronic pancreatitis. Current opinion in gastroenterology 2013; 29: 544-51. [PMID: 23872486]

Chowdhury SD, Chacko A, Ramakrishna BS, et al. Clinical profile and outcome of chronic pancreatitis in children. Indian pediatrics 2013; 50: 1016-9. [PMID: 23798627]

Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 2000; 119: 1324-32. [PMID: 11054391]

Poulsen JL, Olesen SS, Malver LP, Frokjaer JB, Drewes AM. Pain and chronic pancreatitis: a complex interplay of multiple mechanisms. World journal of gastroenterology : WJG 2013;19:7282-91.

Rosch T, Daniel S, Scholz M, et al. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy 2002; 34: 765-71. [PMID: 12244496]

Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. The American journal of gastroenterology 2001; 96: 409-16. [PMID: 11232683]

Parsi MA, Stevens T, Lopez R, Vargo JJ. Extracorporeal shock wave lithotripsy for prevention of recurrent pancreatitis caused by obstructive pancreatic stones. Pancreas 2010; 39: 153-5. [PMID: 19820418]

Duval MK, Jr. Caudal pancreatico-jejunostomy for chronic relapsing pancreatitis. Annals of surgery 1954; 140: 775-85. [PMC: 1609706]

Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA archives of surgery 1958; 76: 898-907. [PMID: 13532132]

O'Neil SJ, Aranha GV. Lateral pancreaticojejunostomy for chronic pancreatitis. World journal of surgery 2003; 27: 1196-202. [PMID: 14534819]

Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Annals of surgery 1960; 152: 1037-43. [ PMC: 1613865]

Forsmark CE. Management of chronic pancreatitis. Gastroenterology 2013; 144: 1282-91 e3. [PMID: 23622138]

Beger HG, Krautzberger W, Bittner R, Buchler M, Limmer J. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery 1985; 97: 467-73. [PMID: 3983823]

Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas 1987; 2: 701-7. [PMID: 3438308]

Whipple AO. Radical Surgery for Certain Cases of Pancreatic Fibrosis associated with Calcareous Deposits. Annals of surgery 1946; 124: 991-1006. [PMID: 17858905]

Prochorov AV, Oldhafer KJ, Tretyak SI, et al. Surgical treatment of pain in patients with chronic

pancreatitis. Hepato-gastroenterology 2012; 59: 1265-9. [PMID: 22580679]

Keck T, Adam U, Makowiec F, et al. Short- and long-term results of duodenum preservation versus resection for the management of chronic pancreatitis: a prospective, randomized study. Surgery 2012; 152: S95-S102. [PMID: 22906892]

Bachmann K, Tomkoetter L, Kutup A, et al. Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pyloruspreserving

pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Annals of surgery 2013; 258: 815-20; discussion 20-1. [PMID: 24096767]

Najarian JS, Sutherland DE, Matas AJ, Goetz FC. Human islet autotransplantation following pancreatectomy. Transplantation proceedings 1979; 11: 336-40. [PMID: 109963]

Traverso LW, Kozarek RA. Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis. Annals of surgery 1997; 226: 429-35; discussion 35-8. [PMID: 9351711]

Gall FP, Muhe E, Gebhardt C. Results of partial and total pancreaticoduodenectomy in 117 patients with chronic pancreatitis. World journal of surgery 1981; 5: 269-75. [PMID: 7245796]

Murphy MM, Knaus WJ, 2nd, Ng SC, et al. Total pancreatectomy: a national study. HPB : the official journal of the International Hepato Pancreato Biliary Association 2009; 11:476-82. [PMC: 2756634]

Nathan H, Wolfgang CL, Edil BH, et al. Peri-operative mortality and long-term survival after total

pancreatectomy for pancreatic adenocarcinoma: a population-based perspective. Journal of surgical oncology 2009; 99: 87-92. [PMID: 19021191]

Stauffer JA, Nguyen JH, Heckman MG, et al. Patient outcomes after total pancreatectomy: a single centre contemporary experience. HPB : the official journal of the International Hepato Pancreato Biliary Association 2009; 11: 483-92. [PMID: 19816612]

Casadei R, Monari F, Buscemi S, et al. Total pancreatectomy: indications, operative technique, and results: a single centre experience and review of literature. Updates in surgery 2010; 62:41-6. [PMID: 20845100]

Crippa S, Tamburrino D, Partelli S, et al. Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery 2011;149:79-86. [PMID: 20494386]

Jamil LH, Chindris AM, Gill KR, et al. Glycemic control after total pancreatectomy for intraductal papillary mucinous neoplasm: an exploratory study. HPB surgery : a world journal of hepatic, pancreatic and biliary surgery 2012; 2012: 381328. [PMID: 22966212]

Bellin MD, Freeman ML, Gelrud A, et al. Total pancreatectomy and islet autotransplantation in chronic pancreatitis: Recommendations from PancreasFest. Pancreatology : official journal of theInternational Association of Pancreatology 2014; 14: 27-35.

Dunderdale J, McAuliffe JC, McNeal SF, et al. Should pancreatectomy with islet cell autotransplantation in patients with chronic alcoholic pancreatitis be abandoned? Journal of the American College of Surgeons 2013; 216: 591-6. [PMID: 23521936]

Takita M, Itoh T, Matsumoto S, et al. Autoimmune chronic pancreatitis with IgG4-related pancreatic pseudocyst in a patient undergoing total pancreatectomy followed by autologous islet transplantation: a case report. Pancreas 2013; 42: 175-7. [PMID: 23254915]

Lee BW, Jee JH, Heo JS, et al. The favorable outcome of human islet transplantation in Korea: experiences of 10 autologous transplantations. Transplantation 2005;79:1568-74.[PMID: 15940047]

Balzano G, Carvello M, Piemonti L, et al. Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm. World journal of gastroenterology : WJG 2014; 20: 4030-6. [PMID: 24744593]

Iyegha UP, Asghar JA, Beilman GJ. Total pancreatectomy and islet auto-transplantation as treatment for ampullary adenocarcinoma in the setting of pancreatic ductal disruption secondary to acute necrotizing pancreatitis. A case report. JOP : Journal of the pancreas 2012; 13: 239-42. [PMID: 22406611]

Garraway NR, Dean S, Buczkowski A, et al. Islet autotransplantation after distal pancreatectomy for pancreatic trauma. J Trauma 2009; 67: E187-9. [PMID: 20009652]

Jindal RM, Ricordi C, Shriver CD. Autologous pancreatic islet transplantation for severe trauma. The New England journal of medicine 2010; 362: 1550. [PMID: 20410526]

Balzano G, Maffi P, Nano R, et al. Extending indications for islet autotransplantation in pancreatic surgery. Annals of surgery 2013; 258: 210-8. [PMID: 23751451]

Kobayashi T, Manivel JC, Bellin MD, et al. Correlation of pancreatic histopathologic findings and islet yield in children with chronic pancreatitis undergoing total pancreatectomy and islet autotransplantation. Pancreas 2010; 39: 57-63. [PMID: 19745778]

Chinnakotla S, Bellin MD, Schwarzenberg SJ, et al. Total Pancreatectomy and Islet Autotransplantation in Children for Chronic Pancreatitis: Indication, Surgical Techniques, Postoperative Management, and Long-term Outcomes. Annals of surgery 2014. [PMID: 24509206]

Khan KM, Desai CS, Kalb B, et al. MRI prediction of islet yield for autologous transplantation after total pancreatectomy for chronic pancreatitis. Digestive diseases and sciences 2013; 58: 1116-24. [PMID: 23086123]

Choi SH, Hwang HK, Kang CM, Yoon CI, Lee WJ. Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas. Surgical endoscopy 2012; 26: 2072-7. [PMID: 22237756]

Dokmak S, Aussilhou B, Sauvanet A, Ruszniewski P, Levy P, Belghiti J. Hand-assisted laparoscopic total pancreatectomy: a report of two cases. Journal of laparoendoscopic & advanced surgical techniques Part A 2013; 23: 539-44. [PMID: 23551033]

Galvani CA, Rodriguez Rilo H, Samame J, Porubsky M, Rana A, Gruessner RW. Fully robotic-assisted technique for total pancreatectomy with an autologous islet transplant in chronic pancreatitis patients: results of a first series. Journal of the American College of Surgeons 2014; 218: e73-8. [PMID: 24559970]

Zureikat AH, Nguyen T, Boone BA, et al. Robotic total pancreatectomy with or without autologous islet cell transplantation: replication of an open technique through a minimal access approach. Surgical endoscopy 2014. [PMID: 25005012]

Desai CS, Stephenson DA, Khan KM, et al. Novel technique of total pancreatectomy before autologous islet transplants in chronic pancreatitis patients. Journal of the American College of Surgeons 2011; 213: e29-34. [PMID: 21996486]

Chinnakotla S, Radosevich DM, Dunn TB, et al. Long-term outcomes of total pancreatectomy and islet auto transplantation for hereditary/genetic pancreatitis. Journal of the American College of Surgeons 2014; 218: 530-43. [PMID: 24655839]

Wilson GC, Sutton JM, Salehi M, et al. Surgical outcomes after total pancreatectomy and islet cell autotransplantation in pediatric patients. Surgery 2013; 154: 777-83; discussion 83-4. [PMID: 24074415]

Scharp DW, Lacy PE, Santiago JV, et al. Insulin independence after islet transplantation into type I diabetic patient. Diabetes 1990; 39: 515-8. [PMID: 2108071]

Maffi P, Balzano G, Ponzoni M, et al. Autologous pancreatic islet transplantation in human bone marrow. Diabetes 2013;62:3523-31. [PMID: 23733196]

Kawahara T, Kin T, Shapiro AM. A comparison of islet autotransplantation with allotransplantation and factors elevating acute portal pressure in clinical islet transplantation. Journal of hepato-biliary-pancreatic sciences 2012;19:281-8. [PMID: 21879320]

Wilhelm JJ, Bellin MD, Dunn TB, et al. Proposed thresholds for pancreatic tissue volume for safe intraportal islet autotransplantation after total pancreatectomy. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2013;13:3183-91. [PMID: 24148548]

Desai CS, Khan KM, Megawa FB, et al. Influence of liver histopathology on transaminitis following total pancreatectomy and autologous islet transplantation. Digestive diseases and sciences 2013; 58: 1349-54. [PMID: 22688185]

Cantarelli E, Piemonti L. Alternative transplantation sites for pancreatic islet grafts. Current diabetes reports 2011; 11: 364-74. [PMID: 21789599]

Sutherland DE, Radosevich DM, Bellin MD, et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis. Journal of the American College of Surgeons 2012; 214: 409-24; discussion 24-6. [PMID: 22397977]

Bramis K, Gordon-Weeks AN, Friend PJ, et al. Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis. The British journal of surgery 2012; 99: 761-6. [PMID: 22434330]

Walsh RM, Saavedra JR, Lentz G, et al. 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 2012; 16: 1469-77. [PMID: 22673773]

Dorlon M, Owczarski S, Wang H, Adams D, Morgan K. Increase in postoperative insulin requirements does not lead to decreased quality of life after total pancreatectomy with islet cell autotransplantation for chronic pancreatitis. The American surgeon 2013; 79: 676-80. [PMID: 23815999]

Garcea G, Pollard CA, Illouz S, Webb M, Metcalfe MS, Dennison AR. Patient satisfaction and cost-effectiveness following total pancreatectomy with islet cell transplantation for chronic pancreatitis. Pancreas 2013; 42: 322-8. [PMID: 23407482]

Ahmad SA, Lowy AM, Wray CJ, et al. Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis. Journal of the American College of Surgeons 2005; 201: 680-7. [PMID: 16256909]

Kuesters S, Karcz WK, Hopt UT, Keck T. [Laparoscopically assisted total pancreatectomy : Feasible minimally invasive alternative to open resection.]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 2014. [PMID: 24824001]

Kim DH, Kang CM, Lee WJ. Laparoscopic-assisted spleen-preserving and pylorus-preserving total pancreatectomy for main duct type intraductal papillary mucinous tumors of the pancreas: a case report. Surgical laparoscopy, endoscopy & percutaneous techniques 2011; 21: e179-82. [PMID: 21857455]

Kitasato A, Tajima Y, Kuroki T, Adachi T, Kanematsu T. Hand-assisted laparoscopic total pancreatectomy for a main duct intraductal papillary mucinous neoplasm of the pancreas. Surgery today 2011; 41: 306-10. [PMID: 21264776]

Casadei R, Marchegiani G, Laterza M, et al. Total pancreatectomy: doing it with a mini-invasive approach. JOP : Journal of the pancreas 2009; 10: 328-31. [PMID: 19454829]

Dallemagne B, de Oliveira AT, Lacerda CF, D'Agostino J, Mercoli H, Marescaux J. Full laparoscopic total pancreatectomy with and without spleen and pylorus preservation: a feasibility report. Journal of hepato-biliary-pancreatic sciences 2013. [PMID: 23430055]

Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Annals of surgery 2013; 257: 128-32. [PMID: 22868357]

Bhayani NH, Enomoto LM, Miller JL, et al. Morbidity of total pancreatectomy with islet cell auto-transplantation compared to total pancreatectomy alone. HPB : the official journal of the International Hepato Pancreato Biliary Association 2014; 16: 522-7.

Garcea G, Weaver J, Phillips J, et al. Total pancreatectomy with and without islet cell transplantation for chronic pancreatitis: a series of 85 consecutive patients. Pancreas 2009; 38: 1-7. [PMID: 18665009]

Argo JL, Contreras JL, Wesley MM, Christein JD. Pancreatic resection with islet cell autotransplant for the treatment of severe chronic pancreatitis. The American surgeon 2008;74:530-6; discussion 6-7. [PMID: 18556996]

Morgan K, Owczarski SM, Borckardt J, Madan A, Nishimura M, Adams DB. Pain control and quality of life after pancreatectomy with islet autotransplantation for chronic pancreatitis. J Gastrointest Surg. 2012; 16:129- 33; discussion 133-4.[PMID: 22042566]

University of Pittsburgh logo. Pittsburgh, Pennsylvania, USA
How to Cite
RadomskiM., & ZureikatA. (2015). Total Pancreatectomy and Islet Cell Autotransplantation: Outcomes, Controversies and New Techniques. JOP. Journal of the Pancreas, 16(1), 1-10.