Kelsey Cook and Katherine A. Morgan, M.D., outline the details and procedures of the Islet Cell Transplant Program for pancreatitis patients.
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mm hmm. Mhm. The program began in 2000 and Dr Morgan and Dr. Adams, we are the number two largest program in the world in terms of volume. We've done almost 275 surgeries, One in about 20 hospitals that can perform the surgery. We typically do about 20-25 surgeries a year. Our patients with chronic pancreatitis that have an underlying genetic mutations such as CFTR speak or P. R. S. S. One tend to do better. With the surgery. We know our patients with genetic mutations there. Pancreatitis is not going to go away versus someone who maybe drank or had an idiopathic reason. You know, they could stop drinking and the pain might get better. But with genetic pancreatitis it's always gonna be there. So this procedure typically helps them the most. Um if we just perform a total pain protect me. They can have a hard form of diabetes to control. And so we couple that with an eyelet auto transplantation where we take their pancreas and remove the islets and then return those islets back to the patients so that they can have an easier to to control a form of diabetes or hopefully in some cases the insulin free. So the islet cells are the cells that are involved in uh glucose homeostasis. So they have the beta cells that make insulin. So that's an uh an important component. But they also have the alpha cells and the other counter regulatory cells or cells that make the counter regulatory hormones to help maintain glucose. How many stasis Mhm approach to the program is we would get the patient referral either from a referring physician or patients can self refer um would saying their medical records and see what their history is regarding pancreatitis. They would come in for a pre op visit which includes islet cell testing. It's a series of blood work and a glucose tolerance test to evaluate that they're islet cells are functioning and then they would meet with dr morgan and our team which includes her myself R. P. A. R. Dietitian. Um It can include our behavioral medicine team um and our research team. So in the operating room during a total pancreatic to me we removed the whole pancreas in a way that preserves the blood flow until the very last minute. So the islet cells get good blood flow until we remove the pancreas. Along with the pancreas we take out the duodenum along with the end of the bile duct and the spleen due to trying to preserve the blood flow again and just anatomically. That's what makes the most sense. So after we remove the pancreas we immediately put it in a cold solution. Um It's a balanced electrolytes uh similar to University of Wisconsin solution or via span. And this helps to preserve the pancreas until we're able to move it to the lab to have the islets removed. Mhm. The clean lab is where they harvest the islet cells from the pancreas. Um It's a sterile room that they get the pancreas from the O. R. On the day of surgery. It's definitely helpful to have the lab here on M. U. S. C. S. Campus. They use a process where they take the islets and add in a collage genesis which is an enzyme that helps to break down the pancreas. Um And then they run it through a circuit that heats up the solution so that the collage anus works in its optimal setting. And they're able to break down the pancreas and then separate it by weight really or by mass into X. Akron and endocrine tissue. And so they're able to separate the islets from the excitement tissue. And then the islets are placed into a bag of albumin along with some heparin um to help prevent clotting when it goes back in and some antibiotics to help prevent infection. And so that bag is what's taken back to the interventional radiology suite to re infuse into the patient, fuse them carefully by gravity. Uh into the portal vein. We include heparin and the solution to help keep the islets themselves from from clumping together. And then they go through the main portal vein and dispersed themselves into the liver um kind of evenly throughout. Once they get to the end of the blood vessels, it's like a branching tree. The islet cells will start to set up within the liver and they grow their own blood vessels and start to um set up their environment as early as a few days. And um over the course of about a month they really start to mature that um that new environment for themselves. And and so we really see improvement in blood glucose management over that first month and then up to really three months. We see improvement often of the islet function. It's pretty remarkable. My mentors before we both in G. I. Surgery and A. G. I. Medicine had a special interest in pancreatitis for decades. And so it was a natural progression for us to develop this sort of cutting edge technology a decade ago. And so I think that history really makes us a unique environment to take care of the whole patient and not just offer a procedure.
