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. 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.
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.
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.
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