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. 2010 Jan;39(1):57-63.
doi: 10.1097/MPA.0b013e3181b8ff71.

Correlation of pancreatic histopathologic findings and islet yield in children with chronic pancreatitis undergoing total pancreatectomy and islet autotransplantation

Takashi Kobayashi  1 , Juan C Manivel, Melena D Bellin, Annelisa M Carlson, Antoinette Moran, Martin L Freeman, Bernhard J Hering, David E R Sutherland
Affiliations

Correlation of pancreatic histopathologic findings and islet yield in children with chronic pancreatitis undergoing total pancreatectomy and islet autotransplantation

Takashi Kobayashi et al. Pancreas. 2010 Jan.

Abstract

Objectives: The probability of insulin independence after intraportal islet autotransplantation (IAT) for chronic pancreatitis (CP) treated by total pancreatectomy (TP) relates to the number of islets isolated from the excised pancreas. Our goal was to correlate the islet yield with the histopathologic findings and the clinical parameters in pediatric (age, <19 years) CP patients undergoing TP-IAT.

Methods: Eighteen pediatric CP patients aged 5 to 18 years (median, 15.6 years) who underwent TP-IAT were studied. Demographics and clinical history came from medical records. Histopathologic specimens from the pancreas were evaluated for presence and severity of fibrosis, acinar cell atrophy, inflammation, and nesidioblastosis by a surgical pathologist blinded to clinical information.

Results: Fibrosis and acinar atrophy negatively correlated with islet yield (P = 0.02, r = -0.50), particularly in hereditary CP (P = 0.01). Previous duct drainage surgeries also had a strong negative correlation (P = 0.01). Islet yield was better in younger (preteen) children (P = 0.02, r = -0.61) and in those with pancreatitis of shorter duration (P = 0.04, r = -0.39).

Conclusions: For preserving beta cell mass, it is best to perform TP-IAT early in the course of CP in children, and prior drainage procedures should be avoided to maximize the number of islets available, especially in hereditary disease.

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Figures

FIGURE 1.
FIGURE 1.
Histopathologic examination of an excised pancreas showing various degrees of fibrosis, acinar atrophy, inflammation, and nesidioblastosis. Paraffin-embedded sections were prepared and attained with hematoxylin and eosin. A, Example of minimal fibrosis without acinar atrophy or inflammation. Minimal focal periductal fibrosis is seen. B, Example of moderate fibrosis and acinar atrophy. Note the more prominent, focal periductal and septal (interlobular) moderate fibrosis and acinar atrophy (arrows). C, Example of severe fibrosis and atrophy. Note the diffuse severe fibrosis and acinar atrophy; mild chronic inflammation is also present. D, Nesidioblastosis and ductular proliferation are shown (arrowheads).
FIGURE 2.
FIGURE 2.
Correlation between the extent of histological changes and islet yield. There was a negative correlation between the degree of fibrosis and IE per kilogram (A) and between the degree of acinar atrophy and IE per kilogram (B). Degree of fibrosis: 0, absent; 1, minimal; 2, mild; 3, moderate; and 4, severe. Degree of acinar atrophy: 0, absent; 1, minimal; 2, mild; 3, moderate; and 4, severe.
FIGURE 3.
FIGURE 3.
Correlation between age at IAT and duration of CP and islet yield. A, Age at pancreatectomy and IAT correlated with islet yield (IE/kg). B, Duration of CP is also correlated with IE per kilogram. Patient 9 (closed circle) underwent partial pancreatectomy only; all other patients (open circle) underwent total or completion pancreatectomy.
FIGURE 4.
FIGURE 4.
Correlation between nesidioblastosis with islet yield (IE/kg). There was a negative correlation between the degree of nesidioblastosis and IE per kilogram. Nesidioblastosis is scored as 0, absent; 1, mild; 2, moderate; and 3, severe.
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