ORIGINAL ARTICLE
In-hospital and 90-day outcomes after total pancreatectomy with islet autotransplantation for pediatric chronic and acute recurrent pancreatitis

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Total pancreatectomy with islet autotransplantation (TPIAT) is used to treat debilitating chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP) that has failed medical and endoscopic therapy. We performed a retrospective review of TPIAT patients at a free-standing children’s hospital to evaluate perioperative outcomes. Twenty patients (median age 13, 65% female) underwent TPIAT (2015 through 2017). Of the 20 patients, 95% had CP and 1 patient (5%) had ARP alone. Seventy-five percent of the patients had a pancreatitis-associated genetic mutation; 40% had pancreas divisum. The median surgical time was 757 (IQR 657 to 835) minutes. Median islet equivalents per kg of body weight (IEQ/kg) were 6404 (IQR 5018 to 7554). At 90 days postoperatively vs preoperatively, significantly fewer patients were receiving parenteral nutrition (0% vs 25%, P = .006) and opioids (45% vs 75%, P = .01). Short Form 36-Item Health Survey (SF-36) physical health module scores and total scores improved (34.0 preoperatively vs 54.6 at 90 days, P = .008, and 47.1 vs 65.3, P = .007, respectively); SF-10 physical health scores also improved (13.4 vs 33.1, P = .02). Insulin requirement decreased from 0.5 unit/kg/day to 0.4 unit/kg/day between discharge and 90 days (P = .02). TPIAT is an effective option when debilitating disease persists despite maximal medical and endoscopic therapy. Opioid, parenteral nutrition, and exogenous insulin use can successfully be weaned within 90 days after TPIAT, with gains in health-related quality of life.

KEYWORDS

autotransplantation
clinical research/practice
health services and outcomes research
insulin/C-peptide
islet transplantation
nutrition
pediatrics
quality of life (QOL)

Abbreviations

ARP
acute recurrent pancreatitis
BMI
body mass index
CCHMC
Cincinnati Children’s Hospital Medical Center
CFTR
cystic fibrosis transmembrane conductance regulator
CPA1
carboxypeptidase A1
CP
chronic pancreatitis
CTRC
chymotrypsin C
ERCP
endoscopic retrograde cholangiopancreatography
HRQOL
health-related quality of life
ICU
intensive care unit
IEQ
islet equivalents
INSPPIRE
International Study Group of Pediatric Pancreatitis: In Search for a Cure
PN
parenteral nutrition
PRSS1
cationic trypsinogen gene
SF-10
Short Form 10-Item Health Survey
SF-36
Short Form 36-Item Health Survey
SPINK1
serine protease inhibitor Kazal type 1
TPIAT
total pancreatectomy with islet autotransplantation

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Meeting Presentations: This work was presented as an abstract at the American Pediatric Surgical Association (APSA) Meeting, Palm Springs, CA, May 2018.

Jaimie D. Nathan and Maisam Abu-El-Haija contributed equally to the manuscript as co-senior authors.