Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases.

Abstract:

OBJECTIVE:Our objective was to analyze factors predicting outcomes after a total pancreatectomy and islet autotransplantation (TP-IAT). BACKGROUND:Chronic pancreatitis (CP) is increasingly treated by a TP-IAT. Postoperative outcomes are generally favorable, but a minority of patients fare poorly. METHODS:In our single-centered study, we analyzed the records of 581 patients with CP who underwent a TP-IAT. Endpoints included persistent postoperative "pancreatic pain" similar to preoperative levels, narcotic use for any reason, and islet graft failure at 1 year. RESULTS:In our patients, the duration (mean ± SD) of CP before their TP-IAT was 7.1 ± 0.3 years and narcotic usage of 3.3 ± 0.2 years. Pediatric patients had better postoperative outcomes. Among adult patients, the odds of narcotic use at 1 year were increased by previous endoscopic retrograde cholangiopancreatography (ERCP) and stent placement, and a high number of previous stents (>3). Independent risk factors for pancreatic pain at 1 year were pancreas divisum, previous body mass index >30, and a high number of previous stents (>3). The strongest independent risk factor for islet graft failure was a low islet yield-in islet equivalents (IEQ)-per kilogram of body weight. We noted a strong dose-response relationship between the lowest-yield category (<2000 IEQ) and the highest (≥5000 IEQ or more). Islet graft failure was 25-fold more likely in the lowest-yield category. CONCLUSIONS:This article represents the largest study of factors predicting outcomes after a TP-IAT. Preoperatively, the patient subgroups we identified warrant further attention.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Chinnakotla S,Beilman GJ,Dunn TB,Bellin MD,Freeman ML,Radosevich DM,Arain M,Amateau SK,Mallery JS,Schwarzenberg SJ,Clavel A,Wilhelm J,Robertson RP,Berry L,Cook M,Hering BJ,Sutherland DE,Pruett TL

doi

10.1097/SLA.0000000000001453

subject

Has Abstract

pub_date

2015-10-01 00:00:00

pages

610-22

issue

4

eissn

0003-4932

issn

1528-1140

pii

00000658-201510000-00007

journal_volume

262

pub_type

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