Total Pancreatectomy and Islet Autotransplantation in Children for Chronic Pancreatitis

Abstract

Objective Describe the surgical technique, complications and long term outcomes of total pancreatectomy and islet auto transplantation (TP-IAT) in a large series of pediatric patients. Summary Background Data Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, while islet auto transplantation (IAT) potentially can prevent or minimize TP-related diabetes. Methods Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic or surgical treatment between 1989–2012. Results Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (p =<0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (p=0.032), lack of prior Puestow (p=0.018), lower body surface area (p=0.048), IEQ per Kg Body Weight (p=0.001) and total IEQ (100,000) (0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT:(1) male gender, (2) lower body surface area and the (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (OR = 2.62; p value < 0.001). Conclusions TP-IAT provides sustained pain relief and improved quality of life. The β cell function is dependent on islet yield. TP-IAT is an effective therapy for children with painful pancreatitis that fail medical and or endoscopic management

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

“…Because islet isolation requires a special facility and is technically challenging, it is only offered at a limited number of centers, primarily in the United States. Delay in referral of patients for TPIAT that results in progressive fibrosis and loss of islet cells, proceeding with pancreatic resections, or performing some drainage procedures markedly reduce islet yield (151, 158). On the other hand, many CP patients, especially with more advanced disease, may be better served with more traditional approaches.…”

Total Pancreatectomy With Islet Autotransplantation

“…School attendance and activity levels return to normal for essentially all patients. Insulin independence is higher for younger children than for teenagers and adults, and appears durable with limited follow up (64). Among 75 children that received TPIAT for CP unresponsive to medical, endoscopic, or surgical treatment, pain and the severity of pain statistically improved in 90% of patients after TPIAT, with sustained relief from narcotic use.…”

“…Total IEQ was the single factor most strongly associated with insulin independence (OR = 2.62 per 100,000 IEQ). TPIAT is an effective therapy for children with painful pancreatitis that fail medical and/or endoscopic management (13, 64). …”

Total Pancreatectomy With Islet Autotransplantation

“…Insulin independence is higher for younger children than for teenagers and adults, and seems durable with limited follow-up. 66 Among 75 children who received TPIAT for CP unresponsive to medical, endoscopic, or surgical treatment, pain and the severity of pain statistically improved in 90% of patients after TPIAT, with sustained relief from narcotic use. More than 40% achieved insulin independence.…”

“…TPIAT is an effective therapy for children=with painful pancreatitis that fail medical and/or endoscopic management. 13,66 …”