Islet Autotransplant Prevents or Reduces the Need for Insulin in Pancreatectomized Children

NEW YORK (EGMN) – Islet autotransplantation prevented or minimized the need for insulin therapy at 1 year in 8 of 12 children who underwent total pancreatectomy for chronic pancreatitis.

Diabetes with complete insulin dependence would have resulted if these patients had undergone pancreatectomy alone, Dr. Melena D. Bellin said at a joint meeting of the Lawson Wilkins Pediatric Endocrine Society/European Society for Pediatric Endocrinology.

Previously, Dr. Bellin and her colleagues at the University of Minnesota, Minneapolis, reported retrospective findings for a total of 18 children who underwent pancreatectomy with islet autotransplantation (injected into the portal vein) during 1989-2006. At 1 year, 10 children were fully insulin independent while 4 had just partial dependence (once-daily insulin use only). Only 7 still were taking narcotics following surgery, whereas all 18 had required narcotics before surgery (J. Pediatr. Gastroenterol. Nutr. 2008;47:37-44).

Now, the procedure has been found similarly successful in a prospective analysis of 12 children who underwent the combined procedures more recently and were followed for 1 year or longer. The seven girls and five boys had a mean age of 14.7 years at the time of surgery (range 5-18 years), and a mean duration of 1.6 years post surgery. In eight children, the cause of the chronic pancreatitis was hereditary/genetic, in three it was idiopathic, and in one the cause was a pancreatic divisum.

All 12 patients had required narcotics for pain relief prior to surgery. At 6 months to 2 years post surgery, nine were off narcotics completely, one discontinued them for several months and then restarted them but at a lower dose, and two remained on narcotics, but also at a lower dose.

Six of the patients achieved insulin independence at a mean of 4 months post pancreatectomy (range 1-10 months), and remained off insulin at 1 year. Another two patients were able to maintain euglycemia with just one daily insulin shot of 0.25 U/kg per day or less.

Compared with the four patients who became insulin dependent (requiring more than 0.25 U/kg per day), those who were partially or completely insulin independent were significantly younger: All four patients who became insulin dependent following surgery were aged 13 years or older, while three of the six who remained completely insulin independent were preadolescents. Those using minimal or no insulin also had received a significantly greater number of transplanted islets (4,113 vs. 2,251 islet equivalents per kilogram of body weight).

The patients using minimal or no insulin at follow-up had greater C-peptide responses to a 2-hour mixed-meal tolerance test (2.8 vs. 0.3 ng/mL), and none had severe hypoglycemic episodes (requiring assistance to treat or experiencing seizure/loss of consciousness). There was one such episode in one of the four patients who became insulin dependent following surgery, resulting from an accidental insulin pump overdose, Dr. Bellin reported.

It’s not clear why preadolescent children were more likely to achieve insulin independence. It could be due to lower levels of insulin resistance, a more favorable metabolic milieu, “healthier” beta cells, or a greater capacity for beta-cell replication, she suggested.

Dr. Bellin stated that she had no financial relationships to disclose.

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