Nutritional Risks in Patients Undergoing Total Pancreatectomy Islet AutoTransplantation in the POST Consortium

Downs, Elissa; Eaton, Anne; Witkowski, Piotr; Wijkstrom, Martin; Walsh, Matthew; Trikudanathan, Guru; Singh, Vikesh K.; Schwarzenberg, Sarah Jane; Pruett, Timothy L.; Posselt, Andrew M.; Naziruddin, Bashoo; Nathan, Jaimie D.; Mokshagundam, Sri Prakash L.; Morgan, Katherine A.; Lara, Luis F.; Gardner, Timothy B.; Freeman, Martin L.; Ellery, Kate; Chinnakotla, Srinath; Beilman, Gregory J.; Adams, David B.; Ahmad, Syed A.; Abu‐El‐Haija, Maisam; Bellin, Melena D.

doi:10.1007/s11605-023-05770-1

Cited by 4 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Underweight status by body mass index (BMI) prior to TPIAT is rare in children and did not seem to increase at 1-year follow-up assessments in one large multicenter cohort. 22 In this same cohort, a higher percentage of children achieved normal weight status after TPIAT (62% of the cohort at baseline, 76% at 1 year) and a lower percentage of children were overweight after TPIAT (36% of the cohort at baseline, 26% at 1 year). 22 Improvements in growth can be seen in pediatric TPIAT recipients, with significant gains in height, weight, and BMI z scores through 1 and 2 years after the operation.…”

Section: Nutrition/growth Outcomesmentioning

confidence: 70%

“…Those with pre-existing EPI may be more likely to have malnutrition and micronutrient deficiencies prior to TPIAT vs those without pre-existing EPI. 22,36 However, any patient identified as having malnutrition by the Pediatric Malnutrition Validation Tool 37 before TPIAT is at risk for micronutrient deficiencies.…”

Section: Impact Of Pre-existing Disease Statesmentioning

confidence: 99%

“…With the resultant complete EPI and potential for fat malabsorption, fat-soluble vitamin (FSV; A, D, E, and K) deficiencies have been identified in children after TPIAT despite adequate doses of PERT. 22,36 Pancreatic-specific formulations of these multivitamins exist, with the FSVs in a water-soluble form.…”

Section: Posttransplant Conditions Altering Micronutrient Needsmentioning

confidence: 99%

“…Usage of pancreatic-specific multivitamins may be inadequate, either because of knowledge of their importance or insurance coverage, but pediatric providers may be more likely than adult providers to prescribe these specialty formulations to their patients. 22 Vitamin D status is a significant contributor to overall bone health. Impaired bone health can be seen in adults with CP prior to TPIAT, 7 although the frequency is not well known in children.…”

Section: Posttransplant Conditions Altering Micronutrient Needsmentioning

confidence: 99%

“…Low vitamin D levels are common in children prior to TPIAT, with insufficiency (<30 ng/ml) seen in 22%-46%, and deficiency (<20 ng/ml) 40 in 5%-6% of children. 22,36 TPIAT recipients are at increased risk for impaired bone health given intestinal reconstruction and EPI that may lead to further vitamin D malabsorption. This can be seen in one large pediatric cohort at a 1-year TPIAT follow-up with 53% being vitamin D insufficient and 19% being deficient.…”

Section: Posttransplant Conditions Altering Micronutrient Needsmentioning

confidence: 99%

See 4 more Smart Citations

Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient

Downs,

Brun,

Bellin

2023

Nut in Clin Prac

Self Cite

View full text Add to dashboard Cite

For children with diminished quality of life and chronic pain caused by acute recurrent or chronic pancreatitis who are undergoing total pancreatectomy with islet autotransplantation, postoperative nutrition support has several unique characteristics. Surgical complications may lead to delays in nutrition support initiation or require modifications to the regimen. Early postoperative dysmotility requires the use of temporary enteral nutrition until this improves. The resultant complete exocrine pancreatic insufficiency necessitates lifelong pancreatic enzyme replacement therapy and fat‐soluble vitamin supplementation. A low‐oxalate diet is recommended to prevent kidney stones. Carbohydrate counting is needed for the provision of short‐term insulin dosing and possibly long‐term as well, depending on the transplanted islet yield. Children should have careful nutrition assessment and monitoring at several follow‐up visits during the first year, then annually, and at any time with concerns.

show abstract

Section: Nutrition/growth Outcomesmentioning

confidence: 70%

Section: Impact Of Pre-existing Disease Statesmentioning

confidence: 99%

Section: Posttransplant Conditions Altering Micronutrient Needsmentioning

confidence: 99%

Section: Posttransplant Conditions Altering Micronutrient Needsmentioning

confidence: 99%

Section: Posttransplant Conditions Altering Micronutrient Needsmentioning

confidence: 99%

See 3 more Smart Citations

Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient

Downs,

Brun,

Bellin

2023

Nut in Clin Prac

Self Cite

View full text Add to dashboard Cite

show abstract

Nutrition challenges following total pancreatectomy with islet autotransplantation

Hasse,

Meng,

Silpe

et al. 2024

Nut in Clin Prac

Self Cite

View full text Add to dashboard Cite

Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical treatment option for patients with chronic pancreatitis who have not responded to other therapies. TP offers pain relief whereas IAT preserves beta cell mass to reduce endocrine insufficiency. During the surgical procedure, the entire pancreas is removed. Islet cells from the pancreas are then isolated, purified, and infused into the liver via the portal vein. Successful TPIAT relieves pain for a majority of patients but is not without obstacles, specifically gastrointestinal, exocrine, and endocrine challenges. The postoperative phase can be complicated by gastrointestinal symptoms causing patients to have difficulty regaining adequate oral intake. Enteral nutrition is frequently provided as a bridge to oral diet. Patients undergoing TPIAT must be monitored for macronutrient and micronutrient deficiencies following the procedure. Exocrine insufficiency must be treated lifelong with pancreatic enzyme replacement therapy. Endocrine function must be monitored and exogenous insulin provided in the postoperative phase; however, a majority of patients undergoing TPIAT require little or no long‐term insulin. Although TPIAT can be a successful option for patients with chronic pancreatitis, nutrition‐related concerns must be addressed for optimal recovery.

show abstract

Pancreatic Endocrine Insufficiency

Narayanan,

Wayne,

Tharmalingam

et al. 2024

Curr Surg Rep

View full text Add to dashboard Cite

Nutritional Risks in Patients Undergoing Total Pancreatectomy Islet AutoTransplantation in the POST Consortium

Cited by 4 publications

References 19 publications

Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient

Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient

Nutrition challenges following total pancreatectomy with islet autotransplantation

Pancreatic Endocrine Insufficiency

Contact Info

Product

Resources

About