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. 2015 Oct;262(4):610-22.
doi: 10.1097/SLA.0000000000001453.

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

Srinath Chinnakotla  1 , Gregory J Beilman, Ty B Dunn, Melena D Bellin, Martin L Freeman, David M Radosevich, Mustafa Arain, Stuart K Amateau, J Shawn Mallery, Sarah J Schwarzenberg, Alfred Clavel, Joshua Wilhelm, R Paul Robertson, Louise Berry, Marie Cook, Bernhard J Hering, David E R Sutherland, Timothy L Pruett
Affiliations

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

Srinath Chinnakotla et al. Ann Surg. 2015 Oct.

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.

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Conflict of interest statement

Disclosure: The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Mean PCS and MCS scales score and 95% confidence limits for 112 patients—pre-TPIAT and at 1-year post-TPIAT. Reference standard normal population and corresponding 95% confidence intervals.
FIGURE 2
FIGURE 2
Patient survival rates.
FIGURE 3
FIGURE 3
Narcotic use.
FIGURE 4
FIGURE 4
Insulin independence.
FIGURE 5
FIGURE 5
Physical and mental health.
See this image and copyright information in PMC

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