Nutritional Risks in Patients Undergoing Total Pancreatectomy Islet AutoTransplantation in the POST Consortium

Elissa M. Downs, Anne Eaton, Piotr Witkowski, Martin Wijkstrom, Matthew Walsh, Guru Trikudanathan, Vikesh K. Singh, Sarah J. Schwarzenberg, Timothy L. Pruett, Andrew Posselt, Bashoo Naziruddin, Jaimie D. Nathan, Sri Prakash Mokshagundam, Katherine Morgan, Luis F. Lara, Timothy B. Gardner, Martin L. Freeman, Kate Ellery, Srinath Chinnakotla, Gregory J. BeilmanDavid Adams, Syed Ahmad, Maisam Abu-El-Haija, Melena D. Bellin

Research output: Contribution to journalArticlepeer-review


Background and Aims: Total pancreatectomy with islet autotransplantation (TPIAT) can relieve pain for individuals with acute recurrent or chronic pancreatitis. However, TPIAT may increase the risk of poor nutritional status with complete exocrine pancreatic insufficiency, partial duodenectomy, and intestinal reconstruction. Our study's objective was to evaluate nutritional status, anthropometrics, and vitamin levels before and after TPIAT. Methods: The multicenter Prospective Observational Study of TPIAT (POST) collects measures including vitamins A, D, and E levels, pancreatic enzyme dose, and multivitamin (MVI) administration before and 1-year after TPIAT. Using these data, we studied nutritional and vitamin status before and after TPIAT. Results: 348 TPIAT recipients were included (68% adult, 37% male, 93% Caucasian). In paired analyses at 1-year follow-up, vitamin A was low in 23% (vs 9% pre-TPIAT, p < 0.001); vitamin E was low in 11% (vs 5% pre-TPIAT, p = 0.066), and 19% had vitamin D deficiency (vs 12% pre-TPIAT, p = 0.035). Taking a fat-soluble multivitamin (pancreatic MVI) was associated with lower risk for vitamin D deficiency (p = 0.002). Adults were less likely to be on a pancreatic MVI at follow-up (34% vs 66% respectively, p < 0.001). Enzyme dosing was adequate. More adults versus children were overweight or underweight pre- and post-TPIAT. Underweight status was associated with vitamin A (p = 0.014) and E (p = 0.02) deficiency at follow-up. Conclusions: Prevalence of fat-soluble vitamin deficiencies increased after TPIAT, especially if underweight. We strongly advocate that all TPIAT recipients have close post-operative nutritional monitoring, including vitamin levels. Pancreatic MVIs should be given to minimize risk of developing deficiencies.

Original languageEnglish (US)
Pages (from-to)1893-1902
Number of pages10
JournalJournal of Gastrointestinal Surgery
Issue number9
StatePublished - Sep 2023

Bibliographical note

Funding Information:
Prospective Observational Study of TPIAT (POST) consortium, supported by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK, R01-DK109124, PI Melena Bellin).

Funding Information:
MDB discloses the following: research support from Viacyte and Dexcom; advisory role (DSMB) for Insulet. LFL discloses the following: research support from Abbvie, consultant for Abbvie, speaker for Abbvie and Nestle. SJS discloses funding from Gilead and UpToDate. VKS is a consultant for Abbvie and Nestle, and he receives research support from Orgenesis and Theraly.

Publisher Copyright:
© 2023, The Society for Surgery of the Alimentary Tract.


  • Fat-soluble vitamin deficiencies
  • Pancreatitis
  • Supplementation
  • Underweight

PubMed: MeSH publication types

  • Observational Study
  • Multicenter Study
  • Journal Article
  • Research Support, N.I.H., Extramural


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