Pancreas transplant after Total Pancreatectomy
Total pancreatectomy (TP) has been used to treat many of the benign and malignant diseases of the pancreas but it is associated with its attendant total endocrine and exocrine pancreatic insufficiency.
At least one third of these patients will develop “brittle” diabetes mellitus (frequent episodes of hypoglycemic unawareness, hyperglycemia and ketoacidosis) with its associated morbidity and mortality. One fifth of them will also develop secondary diabetic complications over time.
The exocrine insufficiency after a TP further complicates the issue. Even with aggressive pancreatic enzyme replacement therapy, patients continue to have moderate steatorrhea that causes glucose malabsorption and further complicates diabetic management. Another consequence of this apancreatic state is the development of steatohepatitis with progressive liver failure.
Total pancreatectomy is usually done for the following conditions :
Intractable pain associated with Chronic pancreatitis
Multicentric or extensive neuroendocrine tumors
Familial pancreatic cancers with premalignant lesions
Pancreatic neoplasms such as Intraductal papillary mucinous neoplasms (IPMN) with diffuse ductal involvment
Trauma
Pediatric genetic abnormalities
Patients with cystic fibrosis (mutation in CFTR gene) who develop recurrent episodes of acute pancreatitis and ultimately progress to chronic pancreatitis
PTA in patients with a previous total pancreatectomy (in conditions mentioned above) can successfully restore both endocrine and exocrine pancreatic insufficiency and avoid a lifelong insulin and enzyme replacement therapy. It also avoids the need for frequent daily blood glucose measurements and many of the dietary restrictions imposed after Total Pancreatectomy; thus, bringing a definite improvement in the quality of life.
