Professor of Surgery, Emeritus
Department of Surgery, Transplantation Division
University of Minnesota
Factors Predicting Outcomes after a Total Pancreatectomy and Islet Autotransplantation: Lessons Learned from over 500 Cases
Srinath Chinnakotla1,2, Gregory J Beilman1, Ty B Dunn1, Melena D Bellin2,3, Martin L Freeman4, David M Radosevich1, Mustafa Arain4, Sarah J Schwarzenberg2, Joshua Wilhelm3, R. Paul Robertson4, Bernhard J Hering1,3, Timothy L Pruett1, David ER Sutherland1,3.
1Surgery, University of Minnesota, Minneapolis, MN, United States; 2Pediatrics, University of Minnesota, Minneapolis, MN, United States; 3Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, United States; 4Medicine, University of Minnesota, Minneapolis, MN, United States
Objective: Our objective was to analyze factors predicting outcomes after a total pancreatectomy and islet auto transplantation (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-center study, we analyzed the records of 581 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; narcotic use, 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, 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 (< 2,000 IEQ) and the highest (≥ 5,000 IEQ or more): islet graft failure was 25-fold more likely in in the lowest-yield category.
Conclusions: This represents the largest study of factors predicting outcomes after a TP-IAT. Preoperatively, the patient subgroups we identified warrant further attention.
12:30 - 13:30
|Pancreatic Beta Cell Replacement Therapy: What Will We Be Doing in 2025?||Solid Pancreas Transplant||Room 111-112|
11:00 - 12:30
|Islet auto transplantation: state-of-the-art||Factors Predicting Outcomes after a Total Pancreatectomy and IsletAutotransplantation: Lessons Learned from over 500 Cases||Plenary Room 1|