For patients with chronic pancreatitis, every day can be a struggle. The condition, an inflammation of the pancreas, impairs a patient’s ability to digest food and may result in constant, unremitting pain.
In the past, patients with this debilitating disease had few options. But for some, there is a groundbreaking new alternative treatment available: islet cell auto-transplantation. The procedure can drastically reduce the pain and suffering experienced by those with chronic pancreatitis.
Chronic pancreatitis can only be cured with complete removal of the pancreas. However, removing the entire pancreas creates diabetes that is extremely difficult to control, with alternating very high and life-threatening low blood sugar. Because of these complications, only a portion of the pancreas typically is removed in an attempt to prevent post-operative diabetes. This treatment does not effectively treat the episodes of pain that lead to recurrent hospital admissions for patients with chronic pancreatitis.
Islet cell auto-transplantation avoids many of those complications. The patient’s pancreas is completely removed, and the islet cells from the pancreas are isolated in a “cleanroom” facility at the Cardiovascular Innovation Institute on the University of Louisville’s Health Sciences Campus. They are then immediately re-implanted into the patient’s liver. The islet cells continue to produce insulin to control blood sugar levels in the body, preventing diabetes.
In 2015, nine patients underwent the procedure, and all have functioning islet cells.
In addition to helping patients with chronic pancreatitis, the auto-transplantation of pancreas islet cells has the potential to impact people with type 1 diabetes. The techniques and skills acquired in auto-transplantation may be applied to patients with diabetes in the future.
Chronic pancreatitis is inflammation of the pancreas that does not heal or improve. It gets worse over time and leads to permanent damage of the organ, eventually impairing a patient’s ability to digest food and make pancreatic hormones.
The pancreas serves two main functions in the body: making enzymes, which help digest proteins, fats and carbohydrates before they can be absorbed in the intestine; and hormones, the most important of which is insulin, which controls how the body uses and stores glucose, its main source of energy.
Individuals with chronic pancreatitis often lose weight, even when their eating habits are normal, because the body does not secrete enough pancreatic enzymes to digest food. Nutrients are not absorbed normally, leading to malnutrition.
Industrialized countries have estimated that approximately 3.5 to 10 people in every 100,000 develop chronic pancreatitis, according to The National Pancreas Foundation. Chronic pancreatitis often develops in patients between the ages of 30 and 40, and is more common in men than women.
Chronic pancreatitis results in more than 122,000 outpatient visits and more than 56,000 hospitalizations per year nationwide. Patients who have chronic pancreatitis may have a decreased quality of life due to pain and often require admission to the hospital for treatment of symptoms.
The exact cause of chronic pancreatitis is unknown, but several factors have been identified that can contribute. They include:
Heavy alcohol use
Genetic mutations due to cystic fibrosis
Blocked pancreatic duct or common bile duct
Pancreatitis that runs in the family
Most people with chronic pancreatitis experience upper abdominal pain, although some have no pain at all. The pain may spread to the back, become worse with eating or drinking, and become constant and disabling. In some cases, the abdominal pain goes away as the condition worsens. Other symptoms include:
Islet cell auto-transplantation is for patients whose pain remains incapacitating despite standard medical and surgical approaches. It is not for everyone, but can yield significant relief of symptoms.
It is performed to prevent diabetes or reduce the severity of diabetes after removal of the pancreas, which is the only cure for chronic pancreatitis. Removing the entire pancreas creates diabetes that is extremely difficult to control due to loss of insulin-producing islet cells.
With islet cell auto-transplantation, the pancreas is removed, and insulin-producing islet cells are immediately separated from the pancreas in a special cleanroom facility. These islet cells are then infused into the patient's liver and the islet cells continue to produce insulin to control blood sugar levels in the body.
Most patients who have had total pancreatectomy with islet auto-transplantation find a dramatic lessening of abdominal pain, reduction in the use of narcotic pain medicine and improved blood sugar control. Since the process involves the re-implantation of the patient’s own cells, the patient does not have to take immunosuppressive medication to ensure the viability of the treatment.
If you have chronic pancreatitis, our multidisciplinary team can help determine if islet cell auto-transplantation or another treatment is right for you. If you are a candidate, you are assured of the highest level of care, and we will do everything we can to make your experience as easy as possible.
Significant pain associated with chronic pancreatitis can seriously reduce a patient’s quality of life. It is important to treat chronic pancreatitis as soon as it is diagnosed because repeated episodes of inflammation can cause irreversible damage, and pain relief becomes much less effective.
University of Louisville Physicians has an active clinical program in islet auto-transplantation (TP-IAT) for chronic pancreatitis and can provide services for other hospitals and medical centers.
We have partnered with the University of Louisville School of Medicine and Jewish Hospital (part of KentuckyOne Health) to offer remote processing of islets for those medical centers wishing to start or maintain their own islet auto-transplant program.
Because of our location in Louisville, Ky., we have unique access to multiple direct flights every evening and are able to ship islets quickly by air anywhere in the continental United States with a high level of control. We are also able to ship by ground.
In addition to processing islets, we can provide clinical and administrative consulting services and training for new programs. This includes patient care and reimbursement.
Establishing a TP-IAT program
Total pancreatectomy with islet auto-transplantation represents an important treatment modality for the care of patients with chronic pancreatitis. It is often the only way to safely cure this disease and is considered medically necessary, and therefore reimbursable by most insurance carriers. The National Pancreas Foundation has identified access to TP-IAT as one of the criteria for programs applying for NPF Center status. However, establishing a TP-IAT program is very challenging.
Most major centers can safely perform total pancreatectomy and most centers can safely infuse islets. The major hurdle to overcome when trying to establish a TP-IAT program is isolating the islets from the resected pancreas. Setting up a clean cell facility can cost more than $1 million, and staffing it with experienced personnel can be challenging. It is very important to retrieve as many islets as possible as the success of preventing diabetes in patients with chronic pancreatitis is determined primarily by the number of islets transplanted.
The UofL Islet Isolation Team has participated in more than 500 clinical isolations, and our outcomes currently exceed benchmarks.
In addition to helping patients with chronic pancreatitis, the auto-transplantation of pancreas islet cells has the potential to impact people with type 1 diabetes. New clinical trial results from April 2016 show that transplantation of pancreatic islets prevents severe, potentially life-threatening drops in blood sugar in people with type 1 diabetes. The investigators designed the study in consultation with the U.S. Food and Drug Administration to enable potential future licensure of the manufacture of purified human pancreatic islets. Read more about the study, funded by the National Institutes of Health, by clicking here.
With the techniques and skills we have acquired in auto-transplantation, we plan to offer allo-transplantation of islets for type 1 diabetes in the future.
Treatments & Services
University of Louisville Physicians is the first in Kentucky to perform islet cell auto-transplantation. With the University of Louisville School of Medicine - in collaboration with Jewish Hospital, part of KentuckyOne Health - we are among a select group of medical facilities in the world undertaking this work, making us a regional leader in the treatment of pancreatitis. Learn more here.
To request islet remote processing, or for more information on our consulting or training services, email Dr. Michael Hughes at email@example.com, or call islet cell coordinator Tracy Gowan, MSN, APRN, FNP-BC, at 502-587-4358.
We are located at:
Jewish Hospital Transplant Clinic (Transplant Center)
200 Abraham Flexner Way
Louisville, KY 40202
Cardiovascular Innovation Institute (islet cell laboratory)
302 E Muhammad Ali Blvd.
Louisville, KY 40202
Physicians in this practice may not see patients at all locations listed below. For details, please call the appointment line for the location you are interested in visiting.
Referring physicians or patients with chronic pancreatitis can learn more about the procedure, including who might be a candidate, by calling 502-407-3220.
Offices and Clinics
Jewish Hospital Transplant Clinic (Transplant Center) 200 Abraham Flexner Way Louisville, Kentucky 40202 502-583-8303 View Google Map
General Surgery at UofL Physicians Outpatient Center 401 E. Chestnut St. Suite 710 Louisville, Kentucky 40202 502-583-8303 View Google Map
Dr. Sri Mokshagundam, an endocrinologist with University of Louisville Physicians, is the medical director of the islet cell auto-transplantation program. He also is an associate professor at the University of Louisville School of Medicine.
UofL Physicians complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex (including discrimination based on pregnancy, gender identity and sex stereotyping) when providing or administering health-related insurance or other health-related coverage. Click here to view the full nondiscrimination notice.