BACKGROUND: Chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP) in pediatric patients are strongly associated with genetic mutations and lead to pan-parenchymal disease refractory to medical and endoscopic treatment. Our aim was to assess pain resolution and glucose control in patients with CP and ARP following total pancreatectomy with islet auto-transplantation (TPIAT). METHODS: We retrospectively analyzed prospectively collected clinical data of 12 children who developed CP and ARP and underwent TPIAT when 21 years old or younger at the University of Chicago between December 2009 and June 2020. Patients with recurrent or persistent abdominal pain attributed to acute or chronic pancreatic inflammation and a history of medical interventions attempted for the relief of pancreatic pain were selected by a multi-disciplinary team for TPIAT. We followed patients post-operatively and reported data for pre-TPIAT, post-operative day 75, and yearly post-TPIAT. RESULTS: All 12 patients experienced complete resolution of pancreatic pain. The overall insulin-independence rate after 1 year was 66% (8/12) and 50% (3/6) at 4 years. Shorter duration of CP/ARP pre-TPIAT, higher mass of islets infused, and lower BMI, BMI percentile, and BSA were associated with insulin-independence post-TPIAT. CONCLUSIONS: TPIAT is a viable treatment option for pediatric patients with CP and ARP. Pediatric patients undergoing TPIAT for CP achieved resolution of pancreatic-type pain and reduced opioid requirements. The majority were able to achieve insulin-independence which was associated with lower pre-TPIAT BMI and higher islet mass transplanted (i.e., over 2000 IEQ/kg), the latter of which can be achieved by earlier TPIAT. LEVEL OF EVIDENCE: Treatment study, Level IV.
BACKGROUND:Chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP) in pediatric patients are strongly associated with genetic mutations and lead to pan-parenchymal disease refractory to medical and endoscopic treatment. Our aim was to assess pain resolution and glucose control in patients with CP and ARP following total pancreatectomy with islet auto-transplantation (TPIAT). METHODS: We retrospectively analyzed prospectively collected clinical data of 12 children who developed CP and ARP and underwent TPIAT when 21 years old or younger at the University of Chicago between December 2009 and June 2020. Patients with recurrent or persistent abdominal pain attributed to acute or chronic pancreatic inflammation and a history of medical interventions attempted for the relief of pancreatic pain were selected by a multi-disciplinary team for TPIAT. We followed patients post-operatively and reported data for pre-TPIAT, post-operative day 75, and yearly post-TPIAT. RESULTS: All 12 patients experienced complete resolution of pancreatic pain. The overall insulin-independence rate after 1 year was 66% (8/12) and 50% (3/6) at 4 years. Shorter duration of CP/ARP pre-TPIAT, higher mass of islets infused, and lower BMI, BMI percentile, and BSA were associated with insulin-independence post-TPIAT. CONCLUSIONS: TPIAT is a viable treatment option for pediatric patients with CP and ARP. Pediatric patients undergoing TPIAT for CP achieved resolution of pancreatic-type pain and reduced opioid requirements. The majority were able to achieve insulin-independence which was associated with lower pre-TPIAT BMI and higher islet mass transplanted (i.e., over 2000 IEQ/kg), the latter of which can be achieved by earlier TPIAT. LEVEL OF EVIDENCE: Treatment study, Level IV.
Authors: Omid Savari; Karolina Golab; Ling-Jia Wang; Lindsay Schenck; Randall Grose; Martin Tibudan; Sabarinathan Ramachandran; W James Chon; Mitchell C Posner; J Michael Millis; Jeffrey B Matthews; Andres Gelrud; Piotr Witkowski Journal: Am Surg Date: 2015-04 Impact factor: 0.688
Authors: Srinath Chinnakotla; Melena D Bellin; Sarah J Schwarzenberg; David M Radosevich; Marie Cook; Ty B Dunn; Gregory J Beilman; Martin L Freeman; A N Balamurugan; Josh Wilhelm; Barbara Bland; Jose M Jimenez-Vega; Bernhard J Hering; Selwyn M Vickers; Timothy L Pruett; David E R Sutherland Journal: Ann Surg Date: 2014-07 Impact factor: 12.969
Authors: Justyna E Gołębiewska; Piotr J Bachul; Natalie Fillman; Lindsay Basto; Mark R Kijek; Karolina Gołąb; Ling-Jia Wang; Martin Tibudan; Celeste Thomas; Alicja Dębska-Ślizień; Andres Gelrud; Jeffrey B Matthews; J Michael Millis; John Fung; Piotr Witkowski Journal: Transpl Int Date: 2018-11-26 Impact factor: 3.782
Authors: Sarah Jane Schwarzenberg; Melena Bellin; Sohail Z Husain; Monika Ahuja; Bradley Barth; Heather Davis; Peter R Durie; Douglas S Fishman; Steven D Freedman; Cheryl E Gariepy; Matthew J Giefer; Tanja Gonska; Melvin B Heyman; Ryan Himes; Soma Kumar; Veronique D Morinville; Mark E Lowe; Neil E Nuehring; Chee Y Ooi; John F Pohl; David Troendle; Steven L Werlin; Michael Wilschanski; Elizabeth Yen; Aliye Uc Journal: J Pediatr Date: 2014-12-30 Impact factor: 4.406
Authors: John F Pohl; Christine A Limbers; Marie Kay; Annette Harman; Michael Rollins; James W Varni Journal: J Pediatr Gastroenterol Nutr Date: 2012-05 Impact factor: 2.839
Authors: J J Wilhelm; M D Bellin; T B Dunn; A N Balamurugan; T L Pruett; D M Radosevich; S Chinnakotla; S J Schwarzenberg; M L Freeman; B J Hering; D E R Sutherland; G J Beilman Journal: Am J Transplant Date: 2013-10-21 Impact factor: 8.086
Authors: Piotr J Bachul; Karolina Golab; Lindsay Basto; Peter Borek; Laurencia Perea; Martin Tibudan; Jordan S Pyda; Angelica Perez-Gutierrez; John Fung; Jeffrey B Matthews; Piotr Witkowski Journal: Pancreas Date: 2021-01-01 Impact factor: 3.243