TY - JOUR
T1 - Factors predicting outcomes after a total pancreatectomy and islet autotransplantation lessons learned from over 500 cases
AU - Chinnakotla, Srinath
AU - Beilman, Gregory J.
AU - Dunn, Ty B.
AU - Bellin, Melena D.
AU - Freeman, Martin L.
AU - Radosevich, David M.
AU - Arain, Mustafa
AU - Amateau, Stuart K.
AU - Mallery, J. Shawn
AU - Schwarzenberg, Sarah J.
AU - Clavel, Alfred
AU - Wilhelm, Joshua
AU - Robertson, R. Paul
AU - Berry, Louise
AU - Cook, Marie
AU - Hering, Bernhard J.
AU - Sutherland, David E R
AU - Pruett, Timothy L.
N1 - Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Objective: Our objective was to analyze factors predicting outcomes after a total pancreatectomy and islet autotransplantation (TP-IAT). Background: Chronic pancreatitis (CP) is increasingly treated by a TP-IAT. Postoperative outcomes are generally favorable, but a minority of patients fare poorly. Methods: In our single-centered study, we analyzed the records of 581 patients with CP who underwent a TP-IAT. Endpoints included persistent postoperative "pancreatic pain" similar to preoperative levels, narcotic use for any reason, and islet graft failure at 1 year. Results: In our patients, the duration (mean±SD) of CP before their TP-IAT was 7.1±0.3 years and narcotic usage of 3.3±0.2 years. Pediatric patients had better postoperative outcomes. Among adult patients, the odds of narcotic use at 1 year were increased by previous endoscopic retrograde cholangiopancreatography (ERCP) and stent placement, and a high number of previous stents (>3). Independent risk factors for pancreatic pain at 1 year were pancreas divisum, previous body mass index >30, and a high number of previous stents (>3). The strongest independent risk factor for islet graft failure was a low islet yield-in islet equivalents (IEQ)-per kilogram of body weight. We noted a strong dose-response relationship between the lowest-yield category (<2000 IEQ) and the highest (≥5000 IEQ or more). Islet graft failure was 25-fold more likely in the lowest-yield category. Conclusions: This article represents the largest study of factors predicting outcomes after a TP-IAT. Preoperatively, the patient subgroups we identified warrant further attention.
AB - Objective: Our objective was to analyze factors predicting outcomes after a total pancreatectomy and islet autotransplantation (TP-IAT). Background: Chronic pancreatitis (CP) is increasingly treated by a TP-IAT. Postoperative outcomes are generally favorable, but a minority of patients fare poorly. Methods: In our single-centered study, we analyzed the records of 581 patients with CP who underwent a TP-IAT. Endpoints included persistent postoperative "pancreatic pain" similar to preoperative levels, narcotic use for any reason, and islet graft failure at 1 year. Results: In our patients, the duration (mean±SD) of CP before their TP-IAT was 7.1±0.3 years and narcotic usage of 3.3±0.2 years. Pediatric patients had better postoperative outcomes. Among adult patients, the odds of narcotic use at 1 year were increased by previous endoscopic retrograde cholangiopancreatography (ERCP) and stent placement, and a high number of previous stents (>3). Independent risk factors for pancreatic pain at 1 year were pancreas divisum, previous body mass index >30, and a high number of previous stents (>3). The strongest independent risk factor for islet graft failure was a low islet yield-in islet equivalents (IEQ)-per kilogram of body weight. We noted a strong dose-response relationship between the lowest-yield category (<2000 IEQ) and the highest (≥5000 IEQ or more). Islet graft failure was 25-fold more likely in the lowest-yield category. Conclusions: This article represents the largest study of factors predicting outcomes after a TP-IAT. Preoperatively, the patient subgroups we identified warrant further attention.
KW - Chronic pancreatitis
KW - Islet autotransplantation
KW - Total pancreatectomy
UR - http://www.scopus.com/inward/record.url?scp=84941776884&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84941776884&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000001453
DO - 10.1097/SLA.0000000000001453
M3 - Article
C2 - 26366540
AN - SCOPUS:84941776884
SN - 0003-4932
VL - 262
SP - 610
EP - 622
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -