A narrative review on the evolution of islet isolation techniques and improving yields during total pancreatectomy and islet autotransplantation.

Abstract

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.