OBJECTIVE: To determine if islet autotransplantation (IAT) independently improves the quality of life (QoL) in patients after total pancreatectomy and islet autotransplantation (TP-IAT). BACKGROUND: TP-IAT is increasingly being used for intractable chronic pancreatitis. However, the impact of IAT on long-term islet function and QoL is unclear. METHODS: TP-IAT patients at our center >1 year after TP-IAT with ≥1 Short Form-36 QoL measure were included. Patients were classified as insulin-independent or insulin-dependent, and as having islet graft function or failure by C-peptide. The associations of insulin use and islet graft function with QoL measures were analyzed by using a linear mixed model, accounting for time since transplant and within-person correlation. RESULTS: Among 817 islet autograft recipients, 564 patients [median (interquartile range) age: 34 (20, 45) years, 71% female] and 2161 total QoL surveys were included. QoL data were available for >5 years after TP-IAT for 42.7% and for >10 years for 17.3%. Insulin-independent patients exhibited higher QoL in 7 of 8 subscale domains and for Physical Component Summary and Mental Component Summary scores ( P <0.05 for all). Physical Component Summary was 2.91 (SE=0.57) higher in insulin-independent patients ( P <0.001). No differences in QoL were observed between those with and without graft function, but islet graft failure was rare (15% of patients). However, glycosylated hemoglobin was much higher with islet graft failure. CONCLUSIONS: QoL is significantly improved when insulin independence is present, and glycosylated hemoglobin is lower with a functioning islet graft. These data support offering IAT, rather than just performing total pancreatectomy and treating with exogenous insulin.
OBJECTIVE: To determine if islet autotransplantation (IAT) independently improves the quality of life (QoL) in patients after total pancreatectomy and islet autotransplantation (TP-IAT). BACKGROUND: TP-IAT is increasingly being used for intractable chronic pancreatitis. However, the impact of IAT on long-term islet function and QoL is unclear. METHODS: TP-IAT patients at our center >1 year after TP-IAT with ≥1 Short Form-36 QoL measure were included. Patients were classified as insulin-independent or insulin-dependent, and as having islet graft function or failure by C-peptide. The associations of insulin use and islet graft function with QoL measures were analyzed by using a linear mixed model, accounting for time since transplant and within-person correlation. RESULTS: Among 817 islet autograft recipients, 564 patients [median (interquartile range) age: 34 (20, 45) years, 71% female] and 2161 total QoL surveys were included. QoL data were available for >5 years after TP-IAT for 42.7% and for >10 years for 17.3%. Insulin-independent patients exhibited higher QoL in 7 of 8 subscale domains and for Physical Component Summary and Mental Component Summary scores ( P <0.05 for all). Physical Component Summary was 2.91 (SE=0.57) higher in insulin-independent patients ( P <0.001). No differences in QoL were observed between those with and without graft function, but islet graft failure was rare (15% of patients). However, glycosylated hemoglobin was much higher with islet graft failure. CONCLUSIONS: QoL is significantly improved when insulin independence is present, and glycosylated hemoglobin is lower with a functioning islet graft. These data support offering IAT, rather than just performing total pancreatectomy and treating with exogenous insulin.
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: David E R Sutherland; David M Radosevich; Melena D Bellin; Bernard J Hering; Gregory J Beilman; Ty B Dunn; Srinath Chinnakotla; Selwyn M Vickers; Barbara Bland; A N Balamurugan; Martin L Freeman; Timothy L Pruett Journal: J Am Coll Surg Date: 2012-03-06 Impact factor: 6.113
Authors: M D Bellin; S Parazzoli; E Oseid; L D Bogachus; C Schuetz; M E Patti; T Dunn; T Pruett; A N Balamurugan; B Hering; G Beilman; D E R Sutherland; R P Robertson Journal: Am J Transplant Date: 2014-08 Impact factor: 8.086
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