Islet cell transplant after total pancreatectomy leaves patient pain- and insulin-free for 10 years

At age 62, Beth Maley of Terrell, Texas, began experiencing severe stomach pain. She describes sitting in a business meeting with the pain so bad she would want to scream, but she held it in. Amazingly, she never missed a day of work due to the pain.

"I just kept on going until I finally said something's wrong," she says. "In early 2014, I went to my primary care physician who quickly diagnosed me with chronic pancreatitis. He told me if we didn't act quickly, I might get pancreatic cancer. I went to see my regular gastroenterologist who referred me to Baylor University Medical Center."

On March 24, 2014, Ms. Maley underwent total pancreatectomy with islet autotransplant at Baylor Dallas. This innovative procedure has been documented to be very effective in controlling pain and restoring insulin secretion in a large number of patients. Baylor University Medical Center, part of Baylor Scott & White Health, has performed over 250 islet autotransplants, placing it among the top five centers in the United States to offer this procedure in terms of the number of cases.

In this procedure, the pancreas is surgically removed and taken to the laboratory where the patient's own islet cells are extracted. The isolated islet cells are then infused into the patient's liver through the portal vein, and sometimes into the preperitoneal space, where they engraft and begin to produce insulin again. This may allow the patient to become less dependent on insulin or not dependent on insulin at all, thus avoiding a diagnosis of brittle diabetes. Importantly, the patient is relieved of much or all of the pain they had experienced.

According to Ernest Beecherl, MD, FACS, Surgical Director, Islet Autotransplantation, Baylor Dallas' glycemic control outcomes are excellent with one third of patients being insulin free at one year; another third require some supplemental insulin, while the remaining one third of patients are diabetics similar to a type 2 diabetic requiring long- and short-acting insulin.

"Once medical and endoscopic management have failed, surgery is third-line therapy," Dr. Beecherl says. "The main indication for surgery is a sufficiently poor quality of life to go through a large operation that is fraught with complications, most commonly delayed gastric emptying."

Although it took a while for Ms. Maley, now 75, to fully recover, her pancreatitis pain is gone. She did take insulin for a period of months after the transplant until the islet cells started to work. Since March 2015, she has been insulin free, and requires only a once-daily dose of sitagliptin to supplement her islet function. Ms. Maley returns to Baylor Dallas for annual follow-ups. When she was last seen in March 2024, she had no visceral pain, her weight was stable on a regular diet and her HbA1C was 5.3.