Total Pancreatectomy With Islet Autotransplantation for Chronic Pancreatitis

Abstract

Background & aims: Total pancreatectomy with islet autotransplantation (TPIAT) is an emerging but controversial therapy for patients with intractably painful chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). Outcomes of TPIAT have not been validated in multicenter studies.

Methods: The study prospectively enrolled 384 participants, who were a mean age of 30 years (standard deviation [SD],17 years), 34% pediatric, and 62% female, with painful CP or RAP undergoing TPIAT at 12 centers. Numeric pain scores, opioid use, and health-related quality of life (QOL), including physical component summary and mental component summary scores, were collected at baseline, at 6 months, and 1 year post-TPIAT. Predictors of outcomes were evaluated with regression modeling.

Results: Opioid use, assessed over a 14-day interval, decreased from 61% before to 24% at 1 year after TPIAT (P < .001). Daily abdominal pain decreased from 65% to 23%, whereas the mean pain score decreased from 4.9 (SD, 2.3) to 2.3 (SD, 2.5; both P < .001). In a multivariable model, opioid use at 1 year was associated with older age and opioid use pre-TPIAT (odds ratio, 9.21; 95% confidence interval, 3.93-25.7). Physical component summary and mental component summary scores improved by ≥10 points in 58% and 35%, respectively. Higher QOL scores at 1 year were associated with higher scores before surgery and younger age. Mean hemoglobin A_1c was 7% (SD, 1.9%) with 20% insulin independent at 1 year. Duration of disease, pancreas morphology, and etiology did not predict response to TPIAT.

Conclusion: In this prospective multicenter study of patients with intractably painful CP or RAP, TPIAT significantly reduced pain burden and improved QOL. Although young age predicted better outcomes, duration and etiology of disease did not.

Keywords: Chronic Pancreatitis; TPIAT; Total Pancreatectomy With Islet Autotransplantation.