Factors Associated with Insulin and Narcotic Independence after Islet Autotransplantation in Patients with Severe Chronic Pancreatitis

Ahmad, Syed A.; Lowy, Andrew M.; Wray, Curtis J.; D’Alessio, David A.; Choe, Kywran A.; James, Laura E.; Gelrud, Andreas; Matthews, Jeffrey B.; Rilo, Horacio

doi:10.1016/j.jamcollsurg.2005.06.268

Cited by 165 publications

(164 citation statements)

References 21 publications

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“…Notably, the duration of chronic pancreatitis before treatment was not recorded in any of the included studies. Apart from clinical criteria, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were used in the preoperative assessment of severity and grading of chronic pancreatitis in most studies 10,12,14 . Two studies reported the patients' preoperative morphine requirement 12,14 .…”

Section: Resultsmentioning

confidence: 99%

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Bramis

Gordon-Weeks

Friend

et al. 2012

British Journal of Surgery

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Background: Total pancreatectomy and islet autotransplantation (TP/IAT) is a treatment option in a subset of patients with chronic pancreatitis. A systematic review of the literature was performed to evaluate the outcome of this procedure, with an attempt to ascertain when it is indicated. The impact on quality of life was poorly reported. The studies reviewed did not provide evidence for optimal timing of TP/IAT in relation to the evolution of chronic pancreatitis. Conclusion:This systematic review showed that TP/IAT had favourable outcomes with regard to pain reduction. Concurrent IAT enabled a significant proportion of patients to remain independent of insulin supplementation.

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Section: Resultsmentioning

confidence: 99%

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Bramis

Gordon-Weeks

Friend

et al. 2012

British Journal of Surgery

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“…1. 12 studies reporting the outcomes of 677 patients met the inclusion and exclusion criteria [7][8][9][10][11][12][13][14][15][16][17][18]. Main study characteristics were described in Table 1.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…Insulin requirement in insulin-dependent patients was showed in Table 3 reported by seven studies [7,8,11,12,[16][17][18]. The average dose was obviously lower than patients who undergone TP alone.…”

Section: Metabolic Outcomesmentioning

confidence: 99%

Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients [Review]

Zhang

Yao

et al. 2015

Endocr J

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Abstract. Islet autotransplantation (IAT) is a viable treatment for patients with severe chronic pancreatitis, this modality may prevent brittle diabetes mellitus after pancreatectomy. This systematic review and meta-analysis was performed to evaluated the outcomes of IAT after TP and discuss the factors that may affect the efficacy of this procedure. MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1977 to 30 April 2014. Cohort Studies reported patients with IAT after TP were included. The studies and data were identified and extracted by two reviewers independently. Data were analyzed using STATA 12.0 and Comprehensive Meta AnalysisV2 software. Random effects model, meta-regression analysis, sensitivity analysis and publication bias were conducted to improve the comprehens ive analysis. Twelve studies reporting the outcomes of 677 patients were included in this review. The insulin independent rate for IAT after TP at last follow-up was 3.72 per 100 person-years (95% CI: 1.00-6.44). The 30-day mortality was 2.1% (95% CI: 1.2-3.8%). The mortality at last follow-up was 1.09 per 100 person-years (95% CI: 0.21-1.97). Factors associated with incidence density of insulin independence in univariate meta-regression analyses included islet equivalents per kg body weight (IEQ/kgBW) (P=0.026). Our systematic review suggests that IAT is a safe modality for patients with CP need to undergo TP. A significant number of patients will achieve insulin independence for a long time after receiving enough IEQ/kgBW.

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“…White et al 35 reported that insulin independence appeared to be related to the number of islet cells transplanted (>3,000 IEQ/kg). On the other hand, Ahmad et al 36 reported that transplantation of more than 6,635 IEQ/kg was associated with a chance of becoming insulin independent, and that patients with increased body mass indices were less likely to benefit from total pancreatectomy with islet autotransplantation and should be counseled to lose weight before islet autotransplantation. In this report, 40% of 45 chronic pancreatitis patients who underwent total pancreatectomy with autotransplantation were insulin free after a mean follow-up of 18 months.…”

Section: T Kuroki Et Almentioning

confidence: 99%

“…38 It is difficult to quantitatively evaluate the pain that the patient suffers after islet autotransplantation. A Cincinnati group 36 standardized narcotic usage by conversion to morphine equivalents, and found a marked reduction of postoperative morphine equivalents (mean 90 mg) after total pancreatectomy compared with preoperative morphine equivalents (mean 206 mg); in addition, 58% of chronic pancreatitis patients had a notable reduction in chronic abdominal pain as demonstrated by narcotic independence at the last follow-up. The Cincinnati series 39 also reported a significant improvement in quality of life using a validated standard assessment questionnaire (SF-36).…”

Section: T Kuroki Et Almentioning

confidence: 99%

Pancreatic islet autotransplantation with total pancreatectomy for chronic pancreatitis

et al. 2012

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Pain relief and improvement in quality of life are the main targets for treatment of chronic pancreatitis. The use of total pancreatectomy for chronic pancreatitis is a radical and in some ways ideal strategy. However, total pancreatectomy is associated with severe diabetic control problems. Total pancreatectomy with islet autotransplantation can relieve severe pain and prevent post-surgical diabetes. In islet autotransplantation, patients with chronic pancreatitis receive their own islet cells and therefore do not require immunosuppression. In the future, total pancreatectomy with islet autotransplantation may be considered a treatment option for chronic pancreatitis patients.

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Factors Associated with Insulin and Narcotic Independence after Islet Autotransplantation in Patients with Severe Chronic Pancreatitis

Cited by 165 publications

References 21 publications

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients [Review]

Pancreatic islet autotransplantation with total pancreatectomy for chronic pancreatitis

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