In-Hospital and 90 day outcomes after total pancreatectomy with islet autotransplantation for pediatric chronic and acute recurrent pancreatitis

Kotagal, Meera; Slusher, Joyce; Abu‐El‐Haija, Maisam; Ahmad, Syed A.; Brunner, John; Elder, Deborah A.; Goldschneider, Kenneth R.; Hornung, Lindsey; Lin, Tom K.; Ogg, Stephen M.; Palermo, Joseph J.; Rose, James D.; Sekoulopoulos, Stephen; Szabova, Alexandra; Nathan, Jaimie D.

doi:10.1016/j.pan.2018.05.428

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…Participant age, sex, BMI, pancreatitis etiology, duration of pancreatitis, and transplanted IEQ/kg were similar to previously reported cohorts of pediatric patients undergoing TPIAT 6,19 (Table 1). Participant age, sex, BMI, pancreatitis etiology, duration of pancreatitis, and transplanted IEQ/kg were similar to previously reported cohorts of pediatric patients undergoing TPIAT 6,19 (Table 1).…”

Section: Participant Characteristicssupporting

confidence: 83%

“…Twenty-six patients (median age 11 years, range 4-18 years) underwent AST before TPIAT during the study period. Participant age, sex, BMI, pancreatitis etiology, duration of pancreatitis, and transplanted IEQ/kg were similar to previously reported cohorts of pediatric patients undergoing TPIAT 6,19 (Table 1). None of the participants had a history of diabetes (defined as fasting plasma glucose <115 mg/dL and hemoglobin A1c level ≤6.0%) or used insulin prior to surgery.…”

Section: Participant Characteristicssupporting

confidence: 83%

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Utility of arginine stimulation testing in preoperative assessment of children undergoing total pancreatectomy with islet autotransplantation

McEachron

Skube

Yang

et al. 2019

Clinical Transplantation

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Metabolic outcomes after total pancreatectomy with islet autotransplantation (TPIAT) are influenced by the islet mass transplanted. Preclinical and clinical studies indicate that insulin and C-peptide levels measured after intravenous administration of the beta cell secretagogue arginine can be used to estimate the available islet mass. We sought to determine if preoperative arginine stimulation test (AST) results predicted transplanted islet mass and metabolic outcomes in pediatric patients undergoing TPIAT. We evaluated the association of preoperative C-peptide and insulin responses to AST with islet isolation metrics using linear regression, and with postoperative insulin independence using logistic regression. Twenty-six TPIAT patients underwent preoperative AST from 2015 to 2018. The acute C-peptide response to arginine (ACRarg) was correlated with isolated islet equivalents (IEQ; r = 0.59, P = 0.002) and islet number (IPN; r = 0.48, P = 0.013). The acute insulin response to arginine (AIRarg) was not significantly correlated with IEQ (r = 0.38, P = 0.095) or IPN (r = 0.41, P = 0.071). Neither ACRarg nor AIRarg was associated with insulin use at 6 months postoperatively. Preoperative C-peptide response to arginine correlates with islet mass available for transplant in pediatric TPIAT patients. AST represents an additional tool before autotransplant to provide counseling on likely islet mass and to inform quality improvements of islet isolation techniques. K E Y W O R D Sautotransplantation, clinical decision-making, insulin / C-peptide, islet isolation

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Section: Participant Characteristicssupporting

confidence: 83%

Section: Participant Characteristicssupporting

confidence: 83%

Utility of arginine stimulation testing in preoperative assessment of children undergoing total pancreatectomy with islet autotransplantation

McEachron

Skube

Yang

et al. 2019

Clinical Transplantation

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“…Thus, this study revealed no correlation between PCS and MCS QoL and daily insulin requirements (r = −0.016 and r = 0.039, respectively) [ 91 ]. The improved QoL was also shown in some other studies [ 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 ]. Chinnakotla et al observed an improved QoL in 80 patients undergoing TPAIT for HGP [ 31 ].…”

Section: Long-term Results and Quality Of Life In Patients Following Tpaitsupporting

confidence: 78%

Total Pancreatectomy with Autologous Islet Cell Transplantation—The Current Indications

Jabłońska

Mrowiec

2021

JCM

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Total pancreatectomy is a major complex surgical procedure involving removal of the whole pancreatic parenchyma and duodenum. It leads to lifelong pancreatic exocrine and endocrine insufficiency. The control of surgery-induced diabetes (type 3) requires insulin therapy. Total pancreatectomy with autologous islet transplantation (TPAIT) is performed in order to prevent postoperative diabetes and its serious complications. It is very important whether it is safe and beneficial for patients in terms of postoperative morbidity and mortality, and long-term results including quality of life. Small duct painful chronic pancreatitis (CP) is a primary indication for TPAIT, but currently the indications for this procedure have been extended. They also include hereditary/genetic pancreatitis (HGP), as well as less frequent indications such as benign/borderline pancreatic tumors (intraductal papillary neoplasms, neuroendocrine neoplasms) and “high-risk pancreatic stump”. The use of TPAIT in malignant pancreatic and peripancreatic neoplasms has been reported in the worldwide literature but currently is not a standard but rather a controversial management in these patients. In this review, history, technique, indications, and contraindications, as well as short-term and long-term results of TPAIT, including pediatric patients, are described.

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“…Previous work has shown that even in young children, TPIAT can be successfully and safely performed with excellent pain relief and good islet engraftment and function [5,7]. Furthermore, we have recently reported on the resolution of nutritional challenges in children with debilitating ARP and CP, with rapid weaning of TPN support in the short term following TPIAT [9]. When compared to all pediatric patients undergoing TPIAT, CF patients have a similar likelihood of insulin independence and similar glycemic control [10].…”

Section: Discussionmentioning

confidence: 96%

Total pancreatectomy with islet autotransplantation in a pancreatic-sufficient cystic fibrosis patient

Onge

Nathan

Abu‐El‐Haija

et al. 2019

Journal of Cystic Fibrosis

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For children with Cystic Fibrosis (CF) suffering from acute recurrent pancreatitis (ARP), abdominal pain can be severe, difficult to treat, impair their quality of life, affect participation at school, and can lead to chronic opioid dependence. Total pancreatectomy with islet autotransplantation (TPIAT) is an uncommon treatment that is reserved for refractory cases of ARP. We present a case of a 4 year old female with pancreatic-sufficient CF, refractory ARP, frequent hospital admissions for abdominal pain, and continued growth failure despite gastrostomy tube and parenteral nutrition. One year after successful TPIAT, the patient is insulin-independent, growing well, and has not been re-hospitalized for abdominal pain. To our knowledge, this is the youngest patient with CF to undergo TPIAT for debilitating ARP. With CFTR modulators restoring some pancreatic function, CF clinicians should have increased vigilance for the development of ARP.

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In-Hospital and 90 day outcomes after total pancreatectomy with islet autotransplantation for pediatric chronic and acute recurrent pancreatitis

Cited by 4 publications

References 26 publications

Utility of arginine stimulation testing in preoperative assessment of children undergoing total pancreatectomy with islet autotransplantation

Utility of arginine stimulation testing in preoperative assessment of children undergoing total pancreatectomy with islet autotransplantation

Total Pancreatectomy with Autologous Islet Cell Transplantation—The Current Indications

Total pancreatectomy with islet autotransplantation in a pancreatic-sufficient cystic fibrosis patient

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