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Total Pancreatectomy and Islet Autotransplantation in Children for Chronic Pancreatitis: Indication, Surgical Techniques, Postoperative Management, and Long-Term Outcomes

Chinnakotla, Srinath MD*,†; Bellin, Melena D. MD†,‡; Schwarzenberg, Sarah J. MD; Radosevich, David M. PhD, RN*; Cook, Marie MPH*; Dunn, Ty B. MD*; Beilman, Gregory J. MD*; Freeman, Martin L. MD§; Balamurugan, A. N. PhD*; Wilhelm, Josh MS; Bland, Barbara MS, RN*; Jimenez-Vega, Jose M. MD; Hering, Bernhard J. MD*,‡; Vickers, Selwyn M. MD*; Pruett, Timothy L. MD*; Sutherland, David E. R. MD, PhD*,‡

doi: 10.1097/SLA.0000000000000569
Surgical Technique

Objective: Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients.

Background: Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes.

Methods: Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012.

Results: Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P < 0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (P = 0.032), lack of prior Puestow procedure (P = 0.018), lower body surface area (P = 0.048), higher islet equivalents (IEQ) per kilogram body weight (P = 0.001), and total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT: (1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P < 0.001).

Conclusions: Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.

We studied 75 children who underwent total pancreatectomy and islet autotransplantation for chronic pancreatitis that failed medical, endoscopic, or surgical treatment. Pancreatitis pain improved (P = 0.001) in 90% of patients. Thirty-one (41.3%) achieved insulin independence. β-cell function was most dependent upon islet yield. Younger children (younger than 12 years) achieved better outcomes.

Departments of *Surgery and

Pediatrics

Schulze Diabetes Institute

§Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.

Reprints: Srinath Chinnakotla, MD, Department of Surgery, University of Minnesota School of Medicine, 420 Delaware St SE MMC 280, Minneapolis, MN 55455. E-mail: chinni@umn.edu.

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.