Factors predicting outcomes after a total pancreatectomy and islet autotransplantation lessons learned from over 500 cases

Srinath Chinnakotla, Gregory J. Beilman, Ty B. Dunn, Melena D. Bellin, Martin L. Freeman, David M. Radosevich, Mustafa Arain, Stuart K. Amateau, J. Shawn Mallery, Sarah J. Schwarzenberg, Alfred Clavel, Joshua Wilhelm, R. Paul Robertson, Louise Berry, Marie Cook, Bernhard J. Hering, David E R Sutherland, Timothy L. Pruett

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)610-622
Number of pages13
JournalAnnals of surgery
Volume262
Issue number4
DOIs
StatePublished - Oct 1 2015

Keywords

  • Chronic pancreatitis
  • Islet autotransplantation
  • Total pancreatectomy

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