Surgeons with Jewish/UofL/ULP Perform First Islet Cell Auto-transplantation Procedures

People with a debilitating and painful disease have a new treatment option available to them thanks to the collaborative efforts of Jewish Hospital, the University of Louisville and the University of Louisville Physicians.

University of Louisville transplant surgeon Dr. Michael G. Hughes, Jr. and his surgical team at Jewish Hospital remove the patient’s pancreas to have the islet cells extracted.

Jewish Hospital, a part of KentuckyOne Health, and faculty members from the UofL School of Medicine are providing total pancreatectomy with islet cell auto-transplantation for some patients with chronic pancreatitis. Since the start of the year, six patients have undergone the procedure and all have functioning islet cells. The program is funded by an $800,000 grant from the Jewish Heritage Fund for Excellence.

Chronic pancreatitis, inflammation of the pancreas, can only be cured with complete removal of the pancreas (total pancreatectomy). However, removing the entire pancreas creates diabetes that is extremely difficult to control, with alternating very high and dangerous, life-threatening low blood sugars. Therefore, only a portion of the pancreas typically is removed in an attempt to prevent post-operative diabetes. This treatment does not very effectively treat the episodes of pain that lead to recurrent hospital admissions for patients with chronic pancreatitis.
The total pancreatectomy with auto-transplantation of islet cells from the pancreas is an alternative treatment being performed by a handful of facilities around the world, including Jewish Hospital. This procedure involves complete removal of the pancreas. The patient’s islet cells are isolated in a “cleanroom” facility at the Cardiovascular Innovation Institute (a partnership between UofL and the Jewish Heritage Fund for Excellence) and then re-implanted into the patient to prevent diabetes.
“Chronic pancreatitis is a disabling disease that results in constant, unremitting pain” said Michael Hughes Jr., MD, transplant surgeon, Jewish Hospital, and assistant professor of surgery at UofL, and a surgeon with University of Louisville Physicians. “Until now, we have been unable to safely perform these procedures. Islet cell auto-transplant immediately following total pancreatectomy allows us to do this.”

Cardiovascular Innovation Institute Investigator Dr. Balamurugan Appakalai removes the islet cells from the patient’s own pancreas to later be infused back into his liver.

Cardiovascular Innovation Institute Investigator Dr. Balamurugan Appakalai removes the islet cells from the patient’s own pancreas to later be infused back into his liver.

“Complete removal of the pancreas leads to diabetes due to loss of insulin-producing islet cells,” said Balamurugan Appakalai, PhD, known as “Dr. Bala,” an associate professor of surgery, director, Clinical Islet Cell Laboratory at UofL and an investigator with the Cardiovascular Innovation Institute. “Islet cell auto-transplantation is a clinical procedure that is performed to prevent diabetes or reduce the severity of diabetes after removal of the pancreas. After pancreatic tissue is removed during surgery, 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.
According to Dr. Hughes, 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.
The Jewish Heritage Fund for Excellence grant has funded the creation of the islet cell auto-transplant program at Jewish Hospital. The Jewish Heritage Fund for Excellence provides financial assistance to not-for-profit organizations offering programs focused on Jewish culture/identity, health, human services and education.
“We are grateful to the Jewish Heritage Fund for Excellence for its support of Jewish Hospital’s islet cell auto-transplantation program,” said Joe Gilene, president, Jewish Hospital and downtown market leader. “We are among a select group of medical centers in the world undertaking this work that will benefit our patients and help us to become a regional leader in the treatment of pancreatitis.”
“Pioneering the latest treatments in diseases and conditions is one of the primary goals of the University of Louisville Health Sciences Center,” said David L. Dunn, MD, PhD, executive vice president for health affairs at the University of Louisville. “We know that chronic pancreatitis results in more than 122,000 outpatient visits and more than 56,000 hospitalizations per year nationwide. As the only health care provider in the Commonwealth offering islet auto-transplantation, we can drastically reduce the pain and suffering experienced by Kentuckians with chronic pancreatitis.”