Long-term outcomes after total pancreatectomy and islet cell autotransplantation: is it a durable operation?

Abstract

OBJECTIVE:

Total pancreatectomy and islet cell autotransplantation (TPIAT) has been increasingly utilized for the management of chronic pancreatitis (CP) with early success. However, the long-term durability of this operation remains unclear.

METHODS:

All patients undergoing TPIAT for the treatment of CP with 5-year or greater follow-up were identified for inclusion in this single-center observational study. End points included narcotic requirements, glycemic control, islet function, quality of life (QOL), and survival.

RESULTS:

Between 2000 and 2013, 166 patients underwent TPIAT; 112 of these patients had 5-year follow-up data to analyze. All patients underwent successful IAT with a mean of 6027 ± 595 islet equivalents per body weight. There was no perioperative mortality and actuarial survival at 5 years was 94.6%. The narcotic independence rate at 1 year was 55% and continued to improve to 73% at 5-year follow-up (P < 0.05). The insulin independence rate declined over time (38% at 1 year vs 27% at more than 5 years), but insulin requirements remained similar (21.4 vs 24.3 units per day, P = 0.6). All patients achieved stable glycemic control with a median hemoglobin A1C (HgA1C) of 6.9% (range: 5.85%-8.3%). The short form 36-item QOL assessment of a subset of patients available for contact demonstrated continued improvements in all tested modules in patients with at least 5-year follow-up. Two patients developed diabetic complications requiring whole organ pancreas transplant for salvage.

CONCLUSIONS:

This represents one of the largest series examining long-term outcomes after TPIAT. This operation produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, but most patients maintain stable glycemic control.

• Authors: Gregory C Wilson, Jeffrey M Sutton, Daniel E Abbott, Milton T Smith, Andrew M Lowy, Jeffrey B Matthews, Horacio L R Rilo, Nathan Schmulewitz, Marzieh Salehi, Kyuran Choe, John Brunner, Dennis J Hanseman, Jeffrey J Sussman, Michael J Edwards, Syed A Ahmad
• Journal: Annals of surgery (Ann Surg) Vol. 260 Issue 4 Pg. 659-65; discussion 665-7 (Oct 2014) ISSN: 1528-1140 [Electronic] United States
• PMID: 25203883 (Publication Type: Journal Article)

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• Narcotics

Topics

• Abdominal Pain (drug therapy)
• Adolescent
• Adult
• Female
• Follow-Up Studies
• Glycated Hemoglobin (metabolism)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Islets of Langerhans Transplantation
• Male
• Middle Aged
• Narcotics (therapeutic use)
• Pancreatectomy
• Pancreatitis, Chronic (complications, mortality, surgery)
• Quality of Life
• Survival Analysis
• Transplantation, Autologous
• Treatment Outcome
• Young Adult