OBJECTIVE: Total pancreatectomy and islet cell autotransplantation (TPIAT) has been increasingly utilized for the management of chronic pancreatitis (CP) with early success. However, the long-term durability of this operation remains unclear. METHODS: All patients undergoing TPIAT for the treatment of CP with 5-year or greater follow-up were identified for inclusion in this single-center observational study. End points included narcotic requirements, glycemic control, islet function, quality of life (QOL), and survival. RESULTS: Between 2000 and 2013, 166 patients underwent TPIAT; 112 of these patients had 5-year follow-up data to analyze. All patients underwent successful IAT with a mean of 6027 ± 595 islet equivalents per body weight. There was no perioperative mortality and actuarial survival at 5 years was 94.6%. The narcotic independence rate at 1 year was 55% and continued to improve to 73% at 5-year follow-up (P < 0.05). The insulin independence rate declined over time (38% at 1 year vs 27% at more than 5 years), but insulin requirements remained similar (21.4 vs 24.3 units per day, P = 0.6). All patients achieved stable glycemic control with a median hemoglobin A1C (HgA1C) of 6.9% (range: 5.85%-8.3%). The short form 36-item QOL assessment of a subset of patients available for contact demonstrated continued improvements in all tested modules in patients with at least 5-year follow-up. Two patients developed diabetic complications requiring whole organ pancreas transplant for salvage. CONCLUSIONS: This represents one of the largest series examining long-term outcomes after TPIAT. This operation produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, but most patients maintain stable glycemic control.
OBJECTIVE: Total pancreatectomy and islet cell autotransplantation (TPIAT) has been increasingly utilized for the management of chronic pancreatitis (CP) with early success. However, the long-term durability of this operation remains unclear. METHODS: All patients undergoing TPIAT for the treatment of CP with 5-year or greater follow-up were identified for inclusion in this single-center observational study. End points included narcotic requirements, glycemic control, islet function, quality of life (QOL), and survival. RESULTS: Between 2000 and 2013, 166 patients underwent TPIAT; 112 of these patients had 5-year follow-up data to analyze. All patients underwent successful IAT with a mean of 6027 ± 595 islet equivalents per body weight. There was no perioperative mortality and actuarial survival at 5 years was 94.6%. The narcotic independence rate at 1 year was 55% and continued to improve to 73% at 5-year follow-up (P < 0.05). The insulin independence rate declined over time (38% at 1 year vs 27% at more than 5 years), but insulin requirements remained similar (21.4 vs 24.3 units per day, P = 0.6). All patients achieved stable glycemic control with a median hemoglobin A1C (HgA1C) of 6.9% (range: 5.85%-8.3%). The short form 36-item QOL assessment of a subset of patients available for contact demonstrated continued improvements in all tested modules in patients with at least 5-year follow-up. Two patients developed diabetic complications requiring whole organ pancreas transplant for salvage. CONCLUSIONS: This represents one of the largest series examining long-term outcomes after TPIAT. This operation produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, but most patients maintain stable glycemic control.
Authors: George K John; Vikesh K Singh; Robert A Moran; Daniel Warren; Zhaoli Sun; Niraj Desai; Christi Walsh; Rita R Kalyani; Erica Hall; Kenzo Hirose; Martin A Makary; Ellen M Stein Journal: J Gastrointest Surg Date: 2017-01-12 Impact factor: 3.452
Authors: Joshua S Jolissaint; Linda W Langman; Claire L DeBolt; Jacob A Tatum; Allison N Martin; Andrew Y Wang; Daniel S Strand; Victor M Zaydfudim; Reid B Adams; Kenneth L Brayman Journal: Clin Transplant Date: 2016-10-17 Impact factor: 2.863
Authors: M D Bellin; G J Beilman; T B Dunn; T L Pruett; D E R Sutherland; S Chinnakotla; J S Hodges; A Lane; P Ptacek; K L Berry; B J Hering; A Moran Journal: Am J Transplant Date: 2016-08-26 Impact factor: 8.086
Authors: Michael C Young; Jake R Theis; James S Hodges; Ty B Dunn; Timothy L Pruett; Srinath Chinnakotla; Sidney P Walker; Martin L Freeman; Guru Trikudanathan; Mustafa Arain; Paul R Robertson; Joshua J Wilhelm; Sarah J Schwarzenberg; Barbara Bland; Gregory J Beilman; Melena D Bellin Journal: Pancreas Date: 2016-08 Impact factor: 3.327