Islet autotransplantation: Indication beyond chronic pancreatitis

The loss of parenchyma after pancreatectomy causes an extreme disruption of glucose homeostasis known as “pancreatogenic diabetes” which is characterized by disabling episodes of hyperglycemia or hypoglycemia, increased morbidity and mortality, and target organ damage. The number of subjects undergoing pancreatic surgery is increasing, owing to early diagnosis of premalignant lesions and to the referral of patients affected by surgical pancreatic diseases to high-volume institutions. Therefore, a growing number of pancreatectomized patients with long life expectancy is exposed to the risk of pancreatogenic diabetes, with a significant impact on quality and duration of life. Islet autotransplantation (IAT) could offer a valuable option to avoid “pancreatogenic diabetes.” In fact, the most successful islet transplants have been performed in no autoimmune diabetes patients, in an autologous setting, in conjunction with total or near total pancreatectomy for the treatment of pancreatic or hepatobiliary conditions. Here we discuss the feasibility, efficiency, and safety of IAT for the prevention of surgical diabetes after extensive or total pancreatic resection for pancreas disease other than chronic pancreatitis.