Quality of Life Improves for Pediatric Patients After Total Pancreatectomy and Islet Autotransplant for Chronic Pancreatitis

Abstract

BACKGROUND & AIMS Total pancreatectomy and islet autotransplant (TP/IAT) have been used to treat patients with painful chronic pancreatitis. Initial studies indicated that most patients experienced significant pain relief, but there were few validated measures of quality of life. We investigated whether health-related quality of life improved among pediatric patients undergoing TP/IAT. METHODS Nineteen consecutive children (ages 5–18 years) undergoing TP/IAT from December 2006 to December 2009 at the University of Minnesota completed the Medical Outcomes Study 36-item short form (SF-36) health questionnaire before and after surgery. Insulin requirements were recorded. RESULTS Before TP/IAT, patients had below average health-related quality of life, based on data from the SF-36; they had a mean physical component summary (PCS) score of 30 and mental component summary (MCS) score of 34 (2 and 1.5 standard deviations, respectively, below the mean for the U.S. population). By 1 year after surgery, PCS and MCS scores improved to 50 and 46 respectively (global effect, PCS p<0.001, MCS p=0.06). Mean scores improved for all 8 component subscales. More than 60% of IAT recipients were insulin independent or required minimal insulin. Patients with prior surgical drainage procedures (Puestow) had lower yields of islets (P=0.01) and greater incidence of insulin dependence (PCS=0.04). CONCLUSIONS Quality of life (physical and emotional components) significantly improve after TP/IAT in subsets of pediatric patients with severe chronic pancreatitis. Minimal or no insulin was required for most patients, although islet yield was reduced in patients with previous surgical drainage operations.

Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

“…The outcomes in the UMN series have been periodically published (Farney et al, 1991;Farney et al, 1998;Gores et al, 1992;Gruessner et al, 2004;Hering et al, 2004;Jie et al, 2005;Morrow et al, 1984;Najarian et al, 1979;Najarian et al, 1980;Najarian et al, 1977;Robertson et al, 2001;Sutherland et al, 1978;Sutherland et al, 1980a;Sutherland et al, 2004a;Sutherland et al, 2009a;Sutherland et al, 2009b;Sutherland et al, 2011b;Wahoff et al, 1995a;Wahoff et al, 1995b), including in children Bellin et al, 2008;Bellin et al, 2010a;Bellin et al, 2010b;Bellin et al, 2011b;Wahoff et.al., 1996).…”

“…Including the cases done outside the University Of Minnesota, IATs have been performed in at least 50 children (not all published) with the majority of islet grafts infused intraportally (Bellin et al, 2008a;Bellin et al, 2011b;Sutherland et al, 2011a). There is one case report of intramuscular autoislet transplant in a 7 year old child; this patient had documented graft function and good metabolic control for over 2 years post-IAT but did not achieve insulin independence (Rafael et al, 2008).…”

“…In the historical series, more than three-quarters of the children had islet function after TP-IAT (Bellin et al, 2008a) Brittle diabetes is very rare after TP-IAT unless virtually no islets are obtained because of delaying the TP until nearly all the islets are destroyed by the disease process Kobayashi et al, 2010) Most important is the effect of TP-IAT on the CP pain syndrome. Sixty to seventy percent of children completely discontinue narcotic pain medications, while the majority of the remaining patients require only intermittent or low dose narcotics for pain control (Bellin et al, 2008a;Bellin et al, 2011b). Complete discontinuation of narcotics is more frequent in preadolescent patients (younger than 13 years of age) (Bellin et al, 2008a).…”

“…The main criterion for success of the islet autograft per se is whether insulin independence is maintained or surgical diabetes made milder. The overall outcome, however, depends as much on the clinical response as on the metabolic results, specifically whether the patient's pain is reduced or eliminated, narcotic analgesics withdrawn, and the quality of life (QOL) improved (Bellin et al, 2010b;Bellin et al, 2011b;Bellin et al, 2011c;Billings et al, 2011;Rafael et al, 2008;Sutton et al, 2010).…”

Hereditary Pancreatitis

“…As with other forms of pancreatitis, epigastric abdominal pain is the most common and disabling symptom, affecting at least 83% of HP patients (48). Though attacks are typically 7 or less days in length (26), smoldering pancreatitis and/or persistent pain can occur in some cases (9). Almost 90% of patients report greater than 5 hospitalizations, with a higher reported hospital admission rate for PRSS1 R122H carriers compared to N29I carriers (0.33 and 0.19 per year, respectively) (26).…”