Latif Javed, Pollard Cristina, Dennison Ashley, Garcea Giuseppe
Department of Hepatopancreatobiliary Surgery, University Hospitals of Leicester, Glenfield, Leicester, United Kingdom.
Ann Hepatobiliary Pancreat Surg. 2025 Aug 31;29(3):240-251. doi: 10.14701/ahbps.25-099. Epub 2025 Jul 24.
Total pancreatectomy with islet autotransplantation (TPIAT) is a specialized treatment for chronic pancreatitis (CP) patients experiencing intractable pain, aiming to preserve endocrine function and enhance quality of life. This narrative review explores the evolution of islet isolation techniques and their impact on yields and clinical outcomes in TPIAT. PubMed and Google Scholar were searched utilizing the keywords: total pancreatectomy, islet autotransplantation, islet transplantation, TPIAT, islet yields, islet isolation. This review underscores significant advances in islet isolation, from initial collagenase-based methods to the automated Ricordi technique and the enzyme Liberase, which have significantly improved islet yield and viability. Factors such as pancreatic fibrosis, preoperative nutritional status, and ischemia times are critical determinants of outcomes. Higher islet yields (> 5,000 islets/kg) correlate with substantially better insulin independence (20%-40% at 1 year), while pain relief (80%-90%) and quality of life improvements (60%-70%) are consistently observed. Variability in yields due to disease severity and levels of technical expertise continues to pose challenges. TPIAT has evolved into a widely accepted treatment option for CP, with advanced islet isolation techniques contributing to enhanced clinical success. Despite these advancements, variability in islet yields and outcomes highlights the need for standardized protocols and optimized preservation techniques. Future research should aim to address challenges associated with fibrosis and improve long-term graft function, thereby maximizing TPIAT's therapeutic potential.
全胰切除术联合胰岛自体移植（TPIAT）是一种针对患有顽固性疼痛的慢性胰腺炎（CP）患者的特殊治疗方法，旨在保留内分泌功能并提高生活质量。本叙述性综述探讨了胰岛分离技术的发展及其对TPIAT中胰岛产量和临床结果的影响。利用关键词“全胰切除术、胰岛自体移植、胰岛移植、TPIAT、胰岛产量、胰岛分离”在PubMed和谷歌学术上进行了检索。本综述强调了胰岛分离技术的重大进展，从最初基于胶原酶的方法到自动化的瑞可德系统技术和 Liberase酶，这些技术显著提高了胰岛产量和活力。胰腺纤维化、术前营养状况和缺血时间等因素是结果的关键决定因素。较高的胰岛产量（>5000个胰岛/千克）与显著更好的胰岛素非依赖状态（1年时为20%-40%）相关，同时持续观察到疼痛缓解（80%-90%）和生活质量改善（60%-70%）。由于疾病严重程度和技术专业水平导致的产量差异仍然是挑战。TPIAT已发展成为一种被广泛接受的CP治疗选择，先进的胰岛分离技术有助于提高临床成功率。尽管有这些进展，但胰岛产量和结果的差异凸显了标准化方案和优化保存技术的必要性。未来的研究应旨在应对与纤维化相关的挑战并改善长期移植物功能，从而最大限度地发挥TPIAT的治疗潜力。
