Objectives We investigated the impact of patient age and disease duration on islet isolation results, diabetes outcomes, and pain outcomes after total pancreatectomy with islet autotransplant (TPIAT) performed in 64 patients with hereditary pancreatitis due to PRSS1 gene mutation. Methods We evaluated the association of patient age and disease duration on islet isolation results and opioid use at 1 year using logistic regression and on graft function using 1-way analysis of variance. Results Islet mass was negatively associated with increasing age and longer disease duration, with a 13% reduction (95% confidence interval [CI], 3%-22%) and 22% (95% CI, 14%-29%) reduction in islet equivalents per kilogram body weight (IEQ/kg) for each 5 years of age and disease duration, respectively. Full graft function was associated with younger age and shorter duration of disease (P < 0.01). Persistent opioid use (15% of patients at 1 year) increased with age (P = 0.05) and disease duration (P = 0.04). Conclusions The TPIAT outcomes were adversely impacted by older age and prolonged disease. In particular, islet mass is lower and risk of diabetes high in older patients with prolonged disease. This should be considered when counseling this subgroup of TPIAT recipients on expected outcomes.
Bibliographical noteFunding Information:
From the *Department of Pediatrics, †Department of Surgery, ‡Schulze Diabetes Institute, §School of Public Health, Division of Biostatistics, and ||Department of Medicine, University of Minnesota Medical School, Minneapolis, MN. Received for publication April 15, 2017; accepted February 1, 2018. Address correspondence to: Melena D. Bellin, MD, Room MB 671, East Bldg, University of Minnesota Masonic Children’s Hospital, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: firstname.lastname@example.org). Dr Melena D. Bellin declares the following financial relationships: Ariel Precision Medicine (advisory board), AbbVie (consulting, past), and Dompe Pharmaceuticals (research grant). M.D.B. and S.C. conceived the study design and concept; M.D.B. performed study supervision; P.P., S.S., M.L.F., T.B.D., J.W., T.L.P., V.K., G.J.B., S.C., and M.B. contributed to study contact and data collection; J.S.H. performed biostatistical analysis; M.D.B., P.P., and J.S.H. authored the first manuscript draft. All authors critically reviewed and contributed to final manuscript revisions. The authors declare no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001028
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
- Acute pancreatitis
- Chronic pancreatitis
- HbA1c - hemoglobin A1c
- Hereditary pancreatitis
- IN - islet number
- PRSS1 - protease serine 1
- TPIAT - total pancreatectomy with islet autotransplant
- Total pancreatectomy