LAUSR

Total pancreatectomy with islet autotransplantation (TPIAT) has been recognized as a treatment option for patients with refractory chronic pancreatitis (CP) who experience debilitating pain and impaired quality of life [1]. Restoring as much endocrine function as possible is crucial to prevent postsurgical diabetes and reduce the risk of brittle diabetes and hypoglycemic unawareness. However, obtaining sufficient islet yield from CP pancreata remains a technical challenge due to chronic inflammation, which damages the morphology of the pancreas. A previous report showed that approximately 20% of TPIAT patients receive a low islet yield (< 2500 IEQ/kg), and those patients have poor metabolic outcomes compared to patients who receive a high islet yield (> 5000 IEQ/kg) [2]. Therefore, salvage therapy is considered for CP patients who develop postsurgical brittle diabetes. Whole-pancreas allogeneic transplantation after TP has been reported to restore both endocrine function and exocrine function [3]. To date, there has been one case report of islet allogeneic transplantation after TP in acute pancreatitis, as islet allogeneic transplantation has largely been restricted to type 1 diabetic patients with severe hypoglycemia and glycemic lability [4]. Thus, it remains unknown if islet allogeneic transplantation could be used as salvage therapy to restore endocrine function after TPIAT following islet graft dysfunction. Here, we report a novel case of allogeneic islet transplantation in a CP patient who had postsurgical diabetes and multiple episodes of hypoglycemic unawareness after TPIAT.