All pediatric patients (≤18 years old) undergoing TP/IAT over a 10-year period (December 2002-June 2012) were identified for inclusion in a single-center, observational cohort study. Retrospective chart review was performed to identify pertinent preoperative, perioperative, and postoperative data, including
narcotic usage,
insulin requirements, etiology of
pancreatitis, previous operative interventions,
operative times, islet cell yields, duration of
hospital stay, and overall quality of life. Quality of life was assessed using the Short Form-36 health questionnaire.
RESULTS: Fourteen pediatric patients underwent TP/IAT for the treatment of CP at the University of Cincinnati with a mean age of 15.9 years (range, 14-18) and a mean body mass index of 21.8 kg/m(2) (range, 14-37). Of the patients, 50% (n = 7) were male and 29% had undergone previous pancreatic operations (1 each of Whipple, Puestow, Frey, and Berne procedures). Etiology of
pancreatitis was idiopathic for 57% (n = 8); the remainder had identified genetic mutations predisposing to
pancreatitis (CFTR, n = 4;
SPINK1, n = 1; PRSS1, n = 1). Mean
operative time was 532 minutes (range, 360-674) with an average hospital duration of stay of 16 days (range, 7-37). Islet cell isolation resulted in mean islet cell equivalents (IEQ) of 500,443 in patients without previous pancreatic surgery versus 413,671 IEQ in patients with prior pancreatic surgery (P = .12). Median patient follow-up was 9 months from surgery (range, 1-78). Preoperatively, patients required on average 32.7
morphine equivalent mg per day (MEQ), which improved to 13.9 MEQ at most recent follow-up. Eleven patients (79%) were
narcotic independent. None of the patients were diabetic preoperatively. All of the patients were discharged after the operation with scheduled
insulin requirements (mean, 17 U/d). This requirement decreased to a mean of 10.1 U/
d at most recent follow-up visit. Four patients (29%) progressed to
insulin independence. All patients in this series achieved stable
glycemic control postoperatively and there was no incidence of "brittle" diabetes. Quality-of-life surveys showed improvement in all tested modules.
CONCLUSION: This study represents one of the largest series examining TP/IAT in the pediatric population. Pediatric patients benefitted from TP/IAT with a decrease in postoperative
narcotic requirements, stable
glycemic control, and improved quality of life.