LongTerm outcomes after total pancreatectomy and islet cell autotransplantation is it a durable operation?

Gregory C. Wilson, Jeffrey M. Sutton, Daniel E. Abbott, Milton T. Smith, Andrew M. Lowy, Jeffrey B. Matthews, Horacio L.R. Rilo, Nathan Schmulewitz, Marzieh Salehi, Kyuran Choe, John Brunner, Dennis J. Hanseman, Jeffrey J. Sussman, Michael J. Edwards, Syed A. Ahmad

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Results: Between 2000 and 2013, 166 patients underwent TPIAT; 112 of these patients had 5year followup data to analyze. All patients underwent successful IAT with a mean of 6027 ± 595 islet equivalents per body weight. There was no perioperative mortality and actuarial survival at 5 years was 94.6%. The narcotic independence rate at 1 year was 55% and continued to improve to 73% at 5year followup (P 0.05). The insulin independence rate declined over time (38% at 1 year vs 27% at more than 5 years), but insulin requirements remained similar (21.4 vs 24.3 units per day, P = 0.6). All patients achieved stable glycemic control with a median hemoglobin A1C (HgA1C) of 6.9% (range: 5.85%-8.3%). The short form 36item QOL assessment of a subset of patients available for contact demonstrated continued improvements in all tested modules in patients with at least 5year followup. Two patients developed diabetic complications requiring whole organ pancreas transplant for salvage.

Objective: Total pancreatectomy and islet cell autotransplantation (TPIAT) has been increasingly utilized for the management of chronic pancreatitis (CP) with early success. However, the longterm durability of this operation remains unclear. Copyright

Methods: All patients undergoing TPIAT for the treatment of CP with 5year or greater followup were identified for inclusion in this singlecenter observational study. End points included narcotic requirements, glycemic control, islet function, quality of life (QOL), and survival.

Conclusions: This represents one of the largest series examining long-term outcomes after TPIAT. This operation produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, but most patients maintain stable glycemic control.

Original languageEnglish (US)
Pages (from-to)659-667
Number of pages9
JournalAnnals of surgery
Volume260
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Chronic pancreatitis
  • Insulin independence
  • Islet cell autotransplantation
  • Longterm outcomes
  • Narcotic independence
  • TPIAT
  • Total pancreatectomy

ASJC Scopus subject areas

  • Surgery

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