How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis?

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: A total pancreatectomy and intraportal islet cell autotransplant (TPIAT) is increasingly being offered to patients with chronic pancreatitis (CP). The benefits include removal of the root cause of pain and amelioration of diabetes. However, the long-term durability of this operation remains unclear. Study Design: Of the 742 patients who have undergone a TPIAT at our center, 215 who did so between 1998 and 2008 now have at least 10 years of follow-up time and were eligible for this single-center observational study. Our outcomes measures included abdominal pain relief, narcotic use, islet graft function (subdivided into 3 groups: insulin independence; partial graft function, defined by C-peptide level > 0.6 mg/dL; and no function, defined by C-peptide level < 0.6 mg/dL), and health-related quality of life. Results: The 10-year actuarial survival rate was 72%. A BMI > 30 kg/m 2 (p = 0.04) predicted 10-year mortality. The rates of pain relief were 82% at 10 years and 90% at 15 years. Narcotic use declined with time: the rates were 50% at 5 years and 37% at 10 years. At 10 years, the rate of insulin independence was 20%; the rate of partial graft function, 32%. Transplantation of islet equivalents/kg > 4,000 was the strongest predictor of islet graft function at 10 years. Pediatric patients were more likely to have islet function than adults (p = 0.01). Health-related quality of life continued to improve at 10 years, even in patients on narcotics. Conclusions: This represents the first and largest series to examine long-term outcomes (10 years or more) in TPIAT patients. In our series, this dual procedure produced durable pain relief and sustained islet graft function, even past 10 years postoperatively.

Original languageEnglish (US)
Pages (from-to)329-339
Number of pages11
JournalJournal of the American College of Surgeons
Volume228
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Islets of Langerhans Transplantation
Pancreatectomy
Cell Transplantation
Chronic Pancreatitis
Islets of Langerhans
Narcotics
Transplants
Autografts
C-Peptide
Pain
Insulin
Therapeutics
Abdominal Pain
Observational Studies
Quality of Life
Outcome Assessment (Health Care)
Pediatrics
Mortality

PubMed: MeSH publication types

  • Journal Article

Cite this

@article{e4c2179a7bb342df9647351f3c40ad3f,
title = "How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis?",
abstract = "Background: A total pancreatectomy and intraportal islet cell autotransplant (TPIAT) is increasingly being offered to patients with chronic pancreatitis (CP). The benefits include removal of the root cause of pain and amelioration of diabetes. However, the long-term durability of this operation remains unclear. Study Design: Of the 742 patients who have undergone a TPIAT at our center, 215 who did so between 1998 and 2008 now have at least 10 years of follow-up time and were eligible for this single-center observational study. Our outcomes measures included abdominal pain relief, narcotic use, islet graft function (subdivided into 3 groups: insulin independence; partial graft function, defined by C-peptide level > 0.6 mg/dL; and no function, defined by C-peptide level < 0.6 mg/dL), and health-related quality of life. Results: The 10-year actuarial survival rate was 72{\%}. A BMI > 30 kg/m 2 (p = 0.04) predicted 10-year mortality. The rates of pain relief were 82{\%} at 10 years and 90{\%} at 15 years. Narcotic use declined with time: the rates were 50{\%} at 5 years and 37{\%} at 10 years. At 10 years, the rate of insulin independence was 20{\%}; the rate of partial graft function, 32{\%}. Transplantation of islet equivalents/kg > 4,000 was the strongest predictor of islet graft function at 10 years. Pediatric patients were more likely to have islet function than adults (p = 0.01). Health-related quality of life continued to improve at 10 years, even in patients on narcotics. Conclusions: This represents the first and largest series to examine long-term outcomes (10 years or more) in TPIAT patients. In our series, this dual procedure produced durable pain relief and sustained islet graft function, even past 10 years postoperatively.",
author = "Bellin, {Melena D} and Beilman, {Gregory J} and Sutherland, {David ER} and Hawa Ali and Arzu Petersen and Mongin, {Steven J} and Varvara Kirchner and Schwarzenberg, {Sarah J} and Trikudanathan, {Guru V} and Freeman, {Martin L} and Pruett, {Timothy L} and Srinath Chinnakotla",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.jamcollsurg.2018.12.019",
language = "English (US)",
volume = "228",
pages = "329--339",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis?

AU - Bellin, Melena D

AU - Beilman, Gregory J

AU - Sutherland, David ER

AU - Ali, Hawa

AU - Petersen, Arzu

AU - Mongin, Steven J

AU - Kirchner, Varvara

AU - Schwarzenberg, Sarah J

AU - Trikudanathan, Guru V

AU - Freeman, Martin L

AU - Pruett, Timothy L

AU - Chinnakotla, Srinath

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: A total pancreatectomy and intraportal islet cell autotransplant (TPIAT) is increasingly being offered to patients with chronic pancreatitis (CP). The benefits include removal of the root cause of pain and amelioration of diabetes. However, the long-term durability of this operation remains unclear. Study Design: Of the 742 patients who have undergone a TPIAT at our center, 215 who did so between 1998 and 2008 now have at least 10 years of follow-up time and were eligible for this single-center observational study. Our outcomes measures included abdominal pain relief, narcotic use, islet graft function (subdivided into 3 groups: insulin independence; partial graft function, defined by C-peptide level > 0.6 mg/dL; and no function, defined by C-peptide level < 0.6 mg/dL), and health-related quality of life. Results: The 10-year actuarial survival rate was 72%. A BMI > 30 kg/m 2 (p = 0.04) predicted 10-year mortality. The rates of pain relief were 82% at 10 years and 90% at 15 years. Narcotic use declined with time: the rates were 50% at 5 years and 37% at 10 years. At 10 years, the rate of insulin independence was 20%; the rate of partial graft function, 32%. Transplantation of islet equivalents/kg > 4,000 was the strongest predictor of islet graft function at 10 years. Pediatric patients were more likely to have islet function than adults (p = 0.01). Health-related quality of life continued to improve at 10 years, even in patients on narcotics. Conclusions: This represents the first and largest series to examine long-term outcomes (10 years or more) in TPIAT patients. In our series, this dual procedure produced durable pain relief and sustained islet graft function, even past 10 years postoperatively.

AB - Background: A total pancreatectomy and intraportal islet cell autotransplant (TPIAT) is increasingly being offered to patients with chronic pancreatitis (CP). The benefits include removal of the root cause of pain and amelioration of diabetes. However, the long-term durability of this operation remains unclear. Study Design: Of the 742 patients who have undergone a TPIAT at our center, 215 who did so between 1998 and 2008 now have at least 10 years of follow-up time and were eligible for this single-center observational study. Our outcomes measures included abdominal pain relief, narcotic use, islet graft function (subdivided into 3 groups: insulin independence; partial graft function, defined by C-peptide level > 0.6 mg/dL; and no function, defined by C-peptide level < 0.6 mg/dL), and health-related quality of life. Results: The 10-year actuarial survival rate was 72%. A BMI > 30 kg/m 2 (p = 0.04) predicted 10-year mortality. The rates of pain relief were 82% at 10 years and 90% at 15 years. Narcotic use declined with time: the rates were 50% at 5 years and 37% at 10 years. At 10 years, the rate of insulin independence was 20%; the rate of partial graft function, 32%. Transplantation of islet equivalents/kg > 4,000 was the strongest predictor of islet graft function at 10 years. Pediatric patients were more likely to have islet function than adults (p = 0.01). Health-related quality of life continued to improve at 10 years, even in patients on narcotics. Conclusions: This represents the first and largest series to examine long-term outcomes (10 years or more) in TPIAT patients. In our series, this dual procedure produced durable pain relief and sustained islet graft function, even past 10 years postoperatively.

UR - http://www.scopus.com/inward/record.url?scp=85062856636&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062856636&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2018.12.019

DO - 10.1016/j.jamcollsurg.2018.12.019

M3 - Article

VL - 228

SP - 329

EP - 339

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 4

ER -