452 Endoscopic autologous transplantation of pancreatic islets underneath gastric mucosa – one-year-follow
Tuesday November 17, 2015 from 11:00 to 12:30
Plenary Room 1

Michal Wszola, Poland

associate professor

Department of General and Transplantation Surgery

Warsaw Medical University

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Endoscopic autologous transplantation of pancreatic islets underneath gastric mucosa – one-year-follow

Michał Wszoła1, Andrzej Berman1, Łukasz Górski1, Agata Ostaszewska1, Marta Serwańska-Świętek1, Janusz Trzebicki2, Andrzej Chmura1, Artur Kwiatkowski1.

1Department of General and Transplant Surgery, Warsaw Medical University, Warsaw, Poland; 2Department of Anaesthesiology and Intensive Care, Warsaw Medical University, Warsaw, Poland

Total pancreatectomy and autologous transplantation of pancreatic islets is a method for the management of patients with painful or severe chronic pancreatitis. In the standard procedure, pancreatic islets are isolated and subsequently administered into the portal vein. Possible complications of this procedure may include portal vein thrombosis or portal hypertension. Unfortunately, in case of patients with a history of thrombosis or patients at risk of thrombosis (history of hepatotropic virus infections), this administration route must not be used. No alternative routes for pancreatic islet transplantation have been developed elsewhere in the world. Animal studies conducted at our site led to the development of a novel method of transplantation of endoscopic pancreatic islets. In 2013, the first autologous transplant procedure was performed, followed by another one in 2014; both procedures consisted in autologous transplantation of pancreatic islets underneath the mucosal membrane in humans. The objective of this study is to present the results of a one-year follow-up of patients after autologous transplantation of pancreatic islets underneath gastric mucosa.
Material and methods: In years 2013-2014, 2 pancreatectomy procedures were performed by Child's method along with subsequent autologous transplantation of pancreatic islets underneath the gastric mucosa of the stomach. Both patients completed the one-year follow-up period.
Results:  The procedure was performed in 2 male patients aged 46 and 39 years, suffering from chronic pancreatitis requiring chronic analgesic treatment. Both patients had been previously diagnosed with diabetes; one was subjected to dietary management while the other received insulin treatment, In both cases, own islet activity was detected, with fasting peptide C levels of 0.81 and 0.6 ng/mL, respectively; the values doubled after glucose challenge test. Hepatotropic virus infections were detected in both cases; in addition, right portal vein thrombosis was diagnosed in one patient. Peptide C concentration after pancreatectomy and before pancreatic cell transplant was 0.1 ng/mL. After the transplant, respective peptide C concentrations in both patients were 0.8 and 0.5 ng/mL on post-transplant day 7; 1.2 and 0.6 ng/mL on day 30; 1.3 and 0.8 ng/mL on day 180, and 1.1 and 0.7 ng/mL on day 360. The pain symptoms resolved in both cases.
Conclusions: Pancreatic islets may survive under the mucosal membrane of the stomach; endoscopic submucosal transplantation may present an alternative management of patients who cannot undergo classic transplant procedure. 

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