Immediate Postoperative Insulin Requirements May Predict Metabolic Outcome after Total Pancreatectomy and Islet Autotransplantation

Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Total pancreatectomy and islet autotransplantation (TPIAT) is a treatment option for patients with CP; however, predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield, and post-TPIAT glucose management data to further understand their relationship. Islet yield, glucose level, and insulin requirement for 72 hours postoperatively were collected for a total of 13 TPIAT recipients between 9-2013 and 9-2018. In addition, their glucose control and basal insulin requirements at 3, 6, and 12 months post-TPIAT were analyzed. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median postoperative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin, or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour postoperatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6, and 12 months showed a positive correlation. Despite the finding of inverse correlation of islet yield with long-term basal insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies. The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long-term insulin management following TPIAT. This observation may identify a high-risk group of patients in need of more intensive diabetes education and insulin treatment prior to hospital discharge.

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OR26-04 Immediate Post-Operative Insulin Requirements May Predict Metabolic Outcome After Total Pancreatectomy and Islet Autologous Cell Transplant (TPIAT)

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.621 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Neha Verma ◽

Amer Rajab ◽

Jill Buss ◽

Luis Lara ◽

Kyle Porter ◽

...

Keyword(s):

Beta Cell Function ◽

Cell Function ◽

Total Pancreatectomy ◽

Inverse Correlation ◽

Insulin Requirement ◽

Cell Transplant ◽

Insulin Requirements ◽

Autologous Cell ◽

Metabolic Outcome

Abstract Immediate Post-Operative Insulin Requirements may Predict Metabolic Outcome after Total Pancreatectomy and Islet Autologous Cell Transplant (TPIAT) Introduction: Chronic pancreatitis (CP) is a progressive disease that leads to eventual loss of endocrine and exocrine function. Patients with CP experience abdominal pain, which in some instances can be refractory to medical and endoscopic intervention. Total pancreatectomy and islet auto transplantation (TPIAT) is a treatment option however predicting postoperative metabolic outcomes remains elusive. In this single-center retrospective study, we report pre-TPIAT characteristics, beta cell function indices, islet yield as well as post-TPIAT glucose management data to further understand their relationship.Methods:A total of 13 TPIAT subjects were included who underwent beta cell function assessment via intravenous glucose tolerance tests and oral mixed meal tolerance tests. Islet yield, glucose level and insulin requirement for 72 hours postoperatively were collected. In addition, their glucose control and insulin requirements at 3, 6 and 12-month post TPIAT were analyzed.Results:The median age was 45 years with median duration of CP for 5 years. The main cause of CP was idiopathic. All 13 subjects had normal baseline fasting glucose levels. Median islet yield was 4882 IEq/kg (interquartile range 3412 to 8987). Median post-operative total insulin requirement on day 3 was 0.43 units/kg. Pre-TPIAT baseline glucose, insulin or c-peptide level did not have a significant correlation with the islet yield. Similarly, there was no correlation between islet yield and insulin requirement at 72-hour post operatively. However, there was an inverse correlation between the absolute islet yield (IEq) and insulin requirement at 6 months and 12 months following post-TPIAT. Further analysis of the relationship between 72-hour post-op insulin requirement and insulin requirement at discharge, 3, 6 and 12 month showed a positive correlation. Despite the new finding of inverse correlation of islet yield with long-term insulin requirement, this study was not able to detect a correlation between the preoperative parameters to postoperative short-term or long-term outcome as noted in other studies.Conclusion: The 72-hour postoperative insulin requirement is a helpful postoperative predictor of patients needing long term insulin management following TPIAT. This observation may identify a high risk group of patients in need of more intensive diabetes education and treatment prior to hospital discharge.

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QS323. Total Pancreatectomy for Pancreatic Adenocarcinoma: Evaluation of Morbidity and Long-Term Outcome

Journal of Surgical Research ◽

10.1016/j.jss.2008.11.630 ◽

2009 ◽

Vol 151 (2) ◽

pp. 297

Author(s):

T.M. Pawlik ◽

S. Reddy ◽

C.L. Wolfgang ◽

B.H. Edil ◽

K.A. Campbell ◽

...

Keyword(s):

Pancreatic Adenocarcinoma ◽

Total Pancreatectomy ◽

Term Outcome ◽

Long Term Outcome

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Increase in Postoperative Insulin Requirements Does Not Lead to Decreased Quality of Life after Total Pancreatectomy with Islet Cell Autotransplantation for Chronic Pancreatitis

The American Surgeon ◽

10.1177/000313481307900710 ◽

2013 ◽

Vol 79 (7) ◽

pp. 676-680 ◽

Cited By ~ 8

Author(s):

Margaret Dorlon ◽

Stephanie Owczarski ◽

Hongjun Wang ◽

David Adams ◽

Katherine Morgan

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Chronic Pancreatitis ◽

Islet Cell ◽

Total Pancreatectomy ◽

Daily Insulin ◽

Insulin Requirements ◽

Islet Autotransplantation ◽

Component Scores

Previous studies have shown that total pancreatectomy with islet cell autotransplantation improves quality of life in chronic pancreatitis. A significant number of these patients develop postoperative hyperglycemia and daily insulin requirements or increase in daily insulin requirements. Our study investigates whether increased insulin requirements postoperatively have a negative impact on quality of life. A prospectively collected database of 74 patients undergoing extensive pancreatectomy with islet autotransplantation for pancreatitis was reviewed. Data pertaining to daily requirements and quality of life (QOL), as measured by the SF-12 questionnaire, in the preoperative and postoperative period were reviewed. Approval from the Institutional Review Board for the evaluation of human subjects was obtained. Seventy-four patients underwent extensive pancreatectomy with islet autotransplantation for pancreatitis. The majority of these patients required new daily insulin or an increase in daily insulin requirements post-operatively. Mean preoperative HA1c in this group was 5.6 with an increase to 7.3 at 6 months postoperatively ( P < 0.001), a mean of 8.1 at 12 months, and 8.9 at 2 years. Mean preoperative daily insulin requirements for this group were five units/day with average increase to 19 units/day at 6 months, 21 units/day at 12 months, and 26 units/day at 2 years. Preoperative QOL scores were a mean of 26 for the physical component and 36 for the mental health component. Postoperatively, physical component scores averaged 33 at 6 months (p < 0.001), 36 at 12 months, and 36 at 2 years; the mental health component scores averaged 42 at 6 months (p = 0.007), 41 at 12 months, and 41 at 2 years. There is no correlation between physical component score or mental component score QOL scores and daily insulin requirements ( r = -0.016 and r = 0.039, respectively). Total pancreatectomy with islet cell autotransplantation is an effective surgery for end-stage chronic pancreatitis. Quality of life significantly improves in physical and mental health components regardless of a postoperative increase in daily insulin requirements.

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Comparative Evaluation of Simple Indices Using a Single Fasting Blood Sample to Estimate Beta Cell Function after Total Pancreatectomy with Islet Autotransplantation

Transplantation Journal ◽

10.1097/01.tp.0000542655.15411.91 ◽

2018 ◽

Vol 102 ◽

pp. S75

Author(s):

Justyna Gołębiewska ◽

Piotr Bachul ◽

Lindsay Basto ◽

Mark Kijek ◽

Natalie Fillman ◽

...

Keyword(s):

Beta Cell ◽

Blood Sample ◽

Beta Cell Function ◽

Comparative Evaluation ◽

Cell Function ◽

Total Pancreatectomy ◽

Islet Autotransplantation

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803 LONG TERM HEALTH-RELATED QUALITY OF LIFE OUTCOMES IN PEDIATRIC PATIENTS UNDERGOING TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION

Gastroenterology ◽

10.1016/s0016-5085(20)34504-2 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1530-S-1531

Author(s):

Michael E. Johnston ◽

Al-Faraaz Kassam ◽

Alexander R. Cortez ◽

Tom K. Lin ◽

Maisam Abu-El-Haija ◽

...

Keyword(s):

Quality Of Life ◽

Pediatric Patients ◽

Total Pancreatectomy ◽

Health Related Quality ◽

Life Outcomes ◽

Related Quality ◽

Health Related ◽

Islet Autotransplantation

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Predictors of Glycemic Outcomes at 1 Year Following Pediatric Total Pancreatectomy With Islet Autotransplantation

10.2337/figshare.17072708 ◽

2022 ◽

Author(s):

Sarah E. Swauger ◽

Lindsey N. Hornung ◽

Deborah A. Elder ◽

Appakalai N. Balamurugan ◽

David S. Vitale ◽

...

Keyword(s):

Surface Area ◽

Body Surface ◽

Total Pancreatectomy ◽

Insulin Requirement ◽

Lower Body ◽

Insulin Independence ◽

C Peptide ◽

High Insulin ◽

Islet Autotransplantation ◽

One Year

Objective: Total pancreatectomy with islet autotransplantation (TPIAT) is indicated to alleviate debilitating pancreas-related pain and mitigate diabetes in patients with acute recurrent and chronic pancreatitis when medical/endoscopic therapies fail. Our aim was to evaluate predictors of insulin requirement at one year following TPIAT in a cohort of children. Research Design and Methods: This was a review of 43 pediatric patients followed after TPIAT for one year or longer. Primary outcome was insulin use at one year, categorized as: insulin independent, low (< 0.5 u/kg/day) or high insulin (≥ 0.5 u/kg/day) requirement. Results: At one year after TPIAT, 12/41 (29%) patients were insulin independent, 21/41 (51%) had low and 8/41 (20%) had high insulin requirement. Insulin independent patients were younger than those with low and high insulin requirement (median age 8.2 vs. 14.6 vs. 13.1 years, respectively; p=0.03). Patients with insulin independence had higher transplanted IEQ/kg (p=0.03) and lower body surface area (p=0.02), compared to those with insulin dependence. Preoperative exocrine insufficiency was associated with high insulin requirement (p=0.03). Higher peak C-peptide measured by stimulated mixed meal tolerance testing (MMTT) at 3 and 6 months post-TPIAT was predictive of lower insulin requirement at one year (p=0.006 and 0.03, respectively). Conclusions: We conclude that insulin independence following pediatric TPIAT is multifactorial and associated with younger age, higher IEQ/kg transplanted and lower body surface area at time of operation. Higher peak C-peptide measured by MMTT following TPIAT confers a higher likelihood of low insulin requirement.

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Predictors of Glycemic Outcomes at 1 Year Following Pediatric Total Pancreatectomy With Islet Autotransplantation

Diabetes Care ◽

10.2337/dc21-1222 ◽

2022 ◽

Author(s):

Sarah E. Swauger ◽

Lindsey N. Hornung ◽

Deborah A. Elder ◽

Appakalai N. Balamurugan ◽

David S. Vitale ◽

...

Keyword(s):

Body Weight ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Total Pancreatectomy ◽

Insulin Requirement ◽

Insulin Independence ◽

C Peptide ◽

High Insulin ◽

Islet Autotransplantation

OBJECTIVE Total pancreatectomy with islet autotransplantation (TPIAT) is indicated to alleviate debilitating pancreas-related pain and mitigate diabetes in patients with acute recurrent and chronic pancreatitis when medical/endoscopic therapies fail. Our aim was to evaluate predictors of insulin requirement at 1 year following TPIAT in a cohort of children. RESEARCH DESIGN AND METHODS This was a review of 43 pediatric patients followed after TPIAT for 1 year or longer. Primary outcome was insulin use at 1 year, categorized as follows: insulin independent, low insulin requirement (<0.5 units/kg/day), or high insulin requirement (≥0.5 units/kg/day). RESULTS At 1 year after TPIAT, 12 of 41 (29%) patients were insulin independent and 21 of 41 (51%) had low and 8 of 41 (20%) had high insulin requirement. Insulin-independent patients were younger than those with low and high insulin requirement (median age 8.2 vs. 14.6 vs. 13.1 years, respectively; P = 0.03). Patients with insulin independence had a higher number of transplanted islet equivalents (IEQ) per kilogram body weight (P = 0.03) and smaller body surface area (P = 0.02), compared with those with insulin dependence. Preoperative exocrine insufficiency was associated with high insulin requirement (P = 0.03). Higher peak C-peptide measured by stimulated mixed-meal tolerance testing (MMTT) at 3 and 6 months post-TPIAT was predictive of lower insulin requirement at 1 year (P = 0.006 and 0.03, respectively). CONCLUSIONS We conclude that insulin independence following pediatric TPIAT is multifactorial and associated with younger age, higher IEQ per kilogram body weight transplanted, and smaller body surface area at time of operation. Higher peak C-peptide measured by MMTT following TPIAT confers a higher likelihood of low insulin requirement.

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Long-term Stability of β-Cell Graft Function After Total Pancreatectomy and Islet Autotransplantation

Pancreas ◽

10.1097/mpa.0000000000001711 ◽

2021 ◽

Vol 50 (1) ◽

pp. e2-e4

Author(s):

Piotr J. Bachul ◽

Karolina Golab ◽

Lindsay Basto ◽

Peter Borek ◽

Laurencia Perea ◽

...

Keyword(s):

Total Pancreatectomy ◽

Graft Function ◽

Β Cell ◽

Term Stability ◽

Long Term Stability ◽

Islet Autotransplantation

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Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis: Do Patients with Prior Pancreatic Surgery Have Different Outcomes?

The American Surgeon ◽

10.1177/000313481207800826 ◽

2012 ◽

Vol 78 (8) ◽

pp. 893-896 ◽

Cited By ~ 13

Author(s):

Katherine A. Morgan ◽

Tom Theruvath ◽

Stefanie Owczarski ◽

David B. Adams

Keyword(s):

Quality Of Life ◽

Chronic Pancreatitis ◽

Pancreatic Surgery ◽

Total Pancreatectomy ◽

Prior History ◽

Insulin Requirements ◽

Surgery Group ◽

History Of ◽

Islet Autotransplantation

Total pancreatectomy with immediate islet autotransplantation (IAT) can be an effective therapy in patients with chronic pancreatitis. Patient selection criteria for radical resection are not well defined. The impact of prior pancreatic surgery on quality of life outcomes in patients undergoing IAT is evaluated. A retrospective review of a prospectively collected database of patients undergoing pancreatectomy with islet autotransplantation was undertaken. Patients having undergone prior pancreatic resection and/or drainage procedures were compared with those without prior pancreatic operative history. Sixty-one patients underwent pancreatectomy with IAT for pancreatitis. Twenty-three patients had a prior history of pancreatic surgery (Group S); 38 had no prior history of pancreatic surgery (Group NS). Demographics between the groups were similar. Patients in Group S took more daily oral morphine equivalents and had a lower psychological quality of life preoperatively. Operative times and blood loss were similar between the patient groups. Islet yields were lower for patients in Group S. Postoperatively, daily insulin requirements at 6 months and 1 year trended higher in Group S. Postoperative quality of life scores at 6 months were improved and similar between the groups. Quality of life metrics continued to improve beyond 1 year of follow-up, with a trend toward greater improvement in the NS Group. Total pancreatectomy for chronic pancreatitis improves quality of life in patients with and without a prior history of pancreatic surgery. This study demonstrates that IAT without preceding pancreatic surgery may enhance outcomes measured by long term insulin requirements and quality of life.

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