SAT-567 - Successful Glycemic Outcomes Following Autologous Islet Cell Transplantation after Total Pancreatectomy

Background: Autologous islet cell transplantation after total pancreatectomy is an emerging therapeutic option for patients with medically refractory chronic pancreatitis requiring surgical removal of the pancreas. The procedure allows partial preservation of endogenous insulin secretion, reduces glycemic variability, and may lessen long-term insulin requirements.

Clinical

Case: A 45-year-old woman with a two-year history of alcohol-induced chronic pancreatitis and non-malignant pancreatic head cysts presented with persistent abdominal pain, nausea, steatorrhea, anorexia, and multiple admissions for pancreatitis flares. After unsuccessful celiac plexus block and pancreatic duct stenting, she underwent total pancreatectomy with percutaneous autologous islet cell transplantation. Islet cell isolation resulted in a modest islet yield of 169,950 islet equivalents. Following islet cell transplant, she was noted to have hyperglycemia and she was discharged on basal and bolus insulin. C-peptide was monitored and noted to be low but detectable, indicating preserved residual endocrine function insufficient for glycemic control. Over the next three months, her basal insulin dose was titrated to 6 units daily, and she was maintained on premeal bolus insulin. She was later transitioned to an insulin pump, with a total daily basal dose of 5.45 units. By four months post-transplant, her total daily insulin dose averaged 9.91 units, with a glucose management indicator of 6.6%, coefficient of variation of 15%, and time-in-range of 100%. C-peptide remained low but detectable, and glycemic stability improved substantially on insulin pump therapy.

Conclusion: This case demonstrates that autologous islet cell transplantation can preserve clinically meaningful endogenous β-cell function following total pancreatectomy for refractory chronic pancreatitis. Even with modest islet isolation yields, it illustrates how the procedure contributes to improved glycemic control, reduced insulin requirements, and enhanced quality of life.

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