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Factors Predicting Outcomes After Total Pancreatectomy And Islet Auto Transplant -Lessons Learned From Over 500 Cases
Srinath Chinnakotla*, Gregory Beilman, Ty Dunn*, Melena Bellin*, Martin Freeman*, Mustafa Arain*, Sarah Jane Schwarzenberg*, David Radosevich*, Alfred Clavel*, David Sutherland, Timothy Pruett
University of Minnesota, Minneapolis, MN

OBJECTIVE(S): Total-Pancreatectomy and islet-cell-auto transplantation (TP/IAT) is being increasingly utilized for the management of chronic-pancreatitis (CP). However, the outcome predictors of this operation remain unclear. 

METHODS: 581patients(including 91 children) undergoing TP/IAT for the treatment of CP at a single-center were analyzed. End points included persistent “Pancreatic pain” similar to pre-surgery, narcotic use for any reason and insulin dependence (multiple daily doses/C peptide negative) at 1 year follow up. Forward and backward step-wise regression models were used to create the 3 best fitting multivariate-logistic-regression models. Potential risk factors included: patient characteristics, surgery related factors (e.g., pancreas fibrosis and islet yield) and previous surgeries and procedures.

RESULTS: Patients had a mean±SD 6.94±6.6 years duration of pancreatitis and 3±2.6 years of narcotic use prior to TP-IAT. Pediatric patients (OR 0.3,LCL 0.88, UCL 0.58,p=0.001) performed better in all three outcomes. Among the adults, for persistent “pancreatic-pain” at 1 year, increasing body mass, familial etiology, pancreas divisum, prior Whipple, and ERCP/>3stents were independent risk factors. Previous ERCP/>3 stents were associated with increase in narcotic use. Prior Puestow/distal pancreatecotmy were associated with lower narcotic use. With adjustment for islet yield, an alcohol etiology and previous Puestow were independent risk factors for insulin dependence (all stats listed in figure1).
CONCLUSIONS: This represents the largest series examining risk factors, outcomes after TP/IAT. The identified patient groups warrant further attention prior to TP-IAT.


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