Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT

Jaimie D Nathan¹, Yi Yang², Anne Eaton², Piotr Witkowski³, Martin Wijkstrom⁴, Matthew Walsh⁵, Guru Trikudanathan⁶, Vikesh K Singh⁷, Sarah J Schwarzenberg⁸, Timothy L Pruett⁹, Andrew Posselt¹⁰, Bashoo Naziruddin¹¹, Sri Prakash Mokshagundam¹², Katherine Morgan¹³, Luis F Lara¹⁴, Varvara Kirchner⁹, Jin He¹⁵, Timothy B Gardner¹⁶, Martin L Freeman⁶, Kate Ellery¹⁷, Darwin L Conwell¹⁴, Srinath Chinnakotla¹⁸, Gregory J Beilman⁹, Syed Ahmad¹⁹, Maisam Abu-El-Haija²⁰, James S Hodges², Melena D Bellin¹⁸

Affiliations

¹ Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. Electronic address: jaimie.nathan@nationwidechildrens.org.
² Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
³ Department of Surgery, University of Chicago, Chicago, IL, USA.
⁴ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵ Department of Surgery, Cleveland Clinic, OH, USA.
⁶ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
⁷ Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁸ Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
⁹ Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁰ Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
¹¹ Islet Cell Processing Laboratory, Baylor Health, Dallas, TX, USA.
¹² Department of Medicine, University of Louisville, Louisville, KY, USA.
¹³ Department of Surgery, The Medical University of South Carolina, Charleston, SC, USA.
¹⁴ Department of Medicine, The Ohio State Wexner University Medical Center, Columbus, OH, USA.
¹⁵ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁶ Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
¹⁷ Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹⁸ Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁹ Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
²⁰ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.

PMID: 34620552
PMCID: PMC8748311
DOI: 10.1016/j.pan.2021.09.011

Observational Study

Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT

Jaimie D Nathan et al. Pancreatology. 2022 Jan.

. 2022 Jan;22(1):1-8.

doi: 10.1016/j.pan.2021.09.011. Epub 2021 Sep 29.

Authors

Affiliations

¹ Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. Electronic address: jaimie.nathan@nationwidechildrens.org.
² Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
³ Department of Surgery, University of Chicago, Chicago, IL, USA.
⁴ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵ Department of Surgery, Cleveland Clinic, OH, USA.
⁶ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
⁷ Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁸ Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
⁹ Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁰ Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
¹¹ Islet Cell Processing Laboratory, Baylor Health, Dallas, TX, USA.
¹² Department of Medicine, University of Louisville, Louisville, KY, USA.
¹³ Department of Surgery, The Medical University of South Carolina, Charleston, SC, USA.
¹⁴ Department of Medicine, The Ohio State Wexner University Medical Center, Columbus, OH, USA.
¹⁵ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁶ Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
¹⁷ Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹⁸ Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA; Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁹ Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
²⁰ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.

PMID: 34620552
PMCID: PMC8748311
DOI: 10.1016/j.pan.2021.09.011

Abstract

Background: Total pancreatectomy with islet autotransplantation (TPIAT) is a viable option for treating debilitating recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) in adults and children. No data is currently available regarding variation in approach to operation.

Methods: We evaluated surgical techniques, islet isolation and infusion approaches, and outcomes and complications, comparing children (n = 84) with adults (n = 195) enrolled between January 2017 and April 2020 by 11 centers in the United States in the Prospective Observational Study of TPIAT (POST), which was launched in 2017 to collect standard history and outcomes data from patients undergoing TPIAT for RAP or CP.

Results: Children more commonly underwent splenectomy (100% versus 91%, p = 0.002), pylorus preservation (93% versus 67%; p < 0.0001), Roux-en-Y duodenojejunostomy reconstruction (92% versus 35%; p < 0.0001), and enteral feeding tube placement (93% versus 63%; p < 0.0001). Median islet equivalents/kg transplanted was higher in children (4577; IQR 2816-6517) than adults (2909; IQR 1555-4479; p < 0.0001), with COBE purification less common in children (4% versus 15%; p = 0.0068). Median length of hospital stay was higher in children (15 days; IQR 14-22 versus 11 days; IQR 8-14; p < 0.0001), but 30-day readmissions were lower in children (13% versus 26%, p = 0.018). Rate of portal vein thrombosis was significantly lower in children than in adults (2% versus 10%, p = 0.028). There were no mortalities in the first 90 days post-TPIAT.

Conclusions: Pancreatectomy techniques differ between children and adults, with islet yields higher in children. The rates of portal vein thrombosis and early readmission are lower in children.

Keywords: Chronic pancreatitis; Islet isolation; Recurrent acute pancreatitis; Surgical techniques; Total pancreatectomy with islet autotransplantation.

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Conflict of interest statement

Declaration of competing interest MDB discloses the following: research support from Viacyte and Dexcom; advisory role (DSMB) for Insulet. LFL discloses the following: research support from Abbvie, consultant for Abbvie, speaker for Abbvie and Nestle. SJS discloses funding from Gilead and UpToDate. VKS is a consultant for Abbvie and Nestle, and he receives research support from Orgenesis and Theraly.

References

1. Hafezi-Nejad N, Singh VK, Johnson SI, Makary MA, Hirose K, Fishman EK, et al. Surgical approaches to chronic pancreatitis: indications and imaging findings. Abdom Radiol (NY). 2016;41(10):1980–96. - PubMed
1. Abu-El-Haija M, Anazawa T, Beilman GJ, Besselink MG, Del Chiaro M, Demir IE, et al. The role of total pancreatectomy with islet autotransplantation in the treatment of chronic pancreatitis: A report from the International Consensus Guidelines in chronic pancreatitis. Pancreatology. 2020;20(4):762–71. - PubMed
1. Chinnakotla S, Beilman GJ, Dunn TB, Bellin MD, Freeman ML, Radosevich DM, et al. Factors predicting outcomes after a total pancreatectomy and islet autotransplantation lessons learned from over 500 cases. Annals of surgery. 2015;262(4):610–22. - PMC - PubMed
1. Morgan KA, Lancaster WP, Owczarski SM, Wang HJ, Borckardt J, Adams DB. Patient Selection for Total Pancreatectomy with Islet Autotransplantation in the Surgical Management of Chronic Pancreatitis. J Am Coll Surgeons. 2018;226(4):446–52. - PubMed
1. McEachron KR, Bellin MD. Total pancreatectomy and islet autotransplantion for chronic and recurrent acute pancreatitis. Curr Opin Gastroenterol. 2018;34(5):367–73. - PMC - PubMed

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Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT

Affiliations

Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous