Total pancreatectomy with islet autotransplantation resolves pain in young children with severe chronic pancreatitis

Melena D. Bellin, Gregory P. Forlenza, Kaustav Majumder, Megan Berger, Martin L. Freeman, Gregory J. Beilman, Ty B. Dunn, Timothy L. Pruett, Michael Murati, Joshua J. Wilhelm, Marie Cook, David E R Sutherland, Sarah J. Schwarzenberg, Srinath Chinnakotla

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives: Fear of diabetes and major surgery may prohibit referral of young children severely affected by pancreatitis for total pancreatectomy with islet autotransplant (TPIAT). We evaluated outcomes in our youngest TPIAT recipients, 3 to 8 years of age at surgery. Methods: Medical records were reviewed for 17 children (9 girls) ages 8 years or younger undergoing TPIAT from 2000 to 2014. Most (14/17) had genetic risk factors for pancreatitis. Since 2006, TPIAT recipients were followed prospectively with health questionnaires including assessments of pain and narcotic use, and scheduled hemoglobin A1c (HbA1c) and mixedmeal tolerance tests (6 mL/kg Boost HP) before surgery, and at regular intervals after. Patients are 1 to 11 years post-TPIAT (median 2.2 years). Data are reported as median (25th, 75th percentile). Results: All had relief of pain, with all 17 patients off narcotics at most recent follow-up. Hospitalization rates decreased from 5.0 hospitalization episodes per person-year of follow-up before TPIAT, to 0.35 episodes per person-year of follow-up after TPIAT. Fourteen (82%) discontinued insulin, higher than the observed insulin independence rate of 41% in 399 patients older than 8 years of age undergoing TPIAT over the same interval (P=0.004). Median post-TPIAT HbA1c was 5.9% (5.6%, 6.3%), and within patient post-TPIAT mean HbA1c was <6.5% for all but 2 patients. Conclusions: Young children with severe refractory chronic pancreatitis may be good candidates for TPIAT, with high rates of pain relief and insulin independence, and excellent glycemic control in the majority.

Original languageEnglish (US)
Pages (from-to)440-445
Number of pages6
JournalJournal of pediatric gastroenterology and nutrition
Volume64
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Pancreatectomy
Autologous Transplantation
Autografts
Chronic Pancreatitis
Pain
Hemoglobins
Narcotics
Insulin
Pancreatitis
Hospitalization
Pain Measurement
Fear
Medical Records
Referral and Consultation

Keywords

  • TPIAT
  • diabetes
  • islet
  • islet autotransplant
  • pancreas surgery
  • pancreatitis
  • total pancreatectomy

Cite this

Total pancreatectomy with islet autotransplantation resolves pain in young children with severe chronic pancreatitis. / Bellin, Melena D.; Forlenza, Gregory P.; Majumder, Kaustav; Berger, Megan; Freeman, Martin L.; Beilman, Gregory J.; Dunn, Ty B.; Pruett, Timothy L.; Murati, Michael; Wilhelm, Joshua J.; Cook, Marie; Sutherland, David E R; Schwarzenberg, Sarah J.; Chinnakotla, Srinath.

In: Journal of pediatric gastroenterology and nutrition, Vol. 64, No. 3, 01.03.2017, p. 440-445.

Research output: Contribution to journalArticle

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abstract = "Objectives: Fear of diabetes and major surgery may prohibit referral of young children severely affected by pancreatitis for total pancreatectomy with islet autotransplant (TPIAT). We evaluated outcomes in our youngest TPIAT recipients, 3 to 8 years of age at surgery. Methods: Medical records were reviewed for 17 children (9 girls) ages 8 years or younger undergoing TPIAT from 2000 to 2014. Most (14/17) had genetic risk factors for pancreatitis. Since 2006, TPIAT recipients were followed prospectively with health questionnaires including assessments of pain and narcotic use, and scheduled hemoglobin A1c (HbA1c) and mixedmeal tolerance tests (6 mL/kg Boost HP) before surgery, and at regular intervals after. Patients are 1 to 11 years post-TPIAT (median 2.2 years). Data are reported as median (25th, 75th percentile). Results: All had relief of pain, with all 17 patients off narcotics at most recent follow-up. Hospitalization rates decreased from 5.0 hospitalization episodes per person-year of follow-up before TPIAT, to 0.35 episodes per person-year of follow-up after TPIAT. Fourteen (82{\%}) discontinued insulin, higher than the observed insulin independence rate of 41{\%} in 399 patients older than 8 years of age undergoing TPIAT over the same interval (P=0.004). Median post-TPIAT HbA1c was 5.9{\%} (5.6{\%}, 6.3{\%}), and within patient post-TPIAT mean HbA1c was <6.5{\%} for all but 2 patients. Conclusions: Young children with severe refractory chronic pancreatitis may be good candidates for TPIAT, with high rates of pain relief and insulin independence, and excellent glycemic control in the majority.",
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AU - Bellin, Melena D.

AU - Forlenza, Gregory P.

AU - Majumder, Kaustav

AU - Berger, Megan

AU - Freeman, Martin L.

AU - Beilman, Gregory J.

AU - Dunn, Ty B.

AU - Pruett, Timothy L.

AU - Murati, Michael

AU - Wilhelm, Joshua J.

AU - Cook, Marie

AU - Sutherland, David E R

AU - Schwarzenberg, Sarah J.

AU - Chinnakotla, Srinath

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