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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*,†

Journal of Pediatric Gastroenterology & Nutrition: March 2017 - Volume 64 - Issue 3 - p 440–445
doi: 10.1097/MPG.0000000000001314
Original Article: Pancreatology

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 mixed-meal 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.

*Department of Pediatrics

Department of Surgery

Department of Radiology

§Department of Medicine, University of Minnesota and Masonic Children's Hospital, Minneapolis, MN

Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO.

Address correspondence and reprint requests to Melena D. Bellin, MD, Associate Professor, Pediatric Endocrinology, University of Minnesota Masonic Children's, East Building, Rm MB-671, 2450 Riverside Ave, Minneapolis, MN 55454 (e-mail: bell0130@umn.edu).

Received 26 December, 2015

Accepted 15 June, 2016

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,