Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases

TLDR

Chronic pancreatitis is increasingly treated with total pancreatectomy and islet autotransplantation, which generally yields favorable outcomes but leaves a minority of patients with poor results, prompting identification of preoperative risk subgroups. The study aims to identify factors that predict postoperative outcomes following total pancreatectomy and islet autotransplantation. The authors retrospectively analyzed 581 chronic pancreatitis patients undergoing TP‑IAT, evaluating persistent pain, narcotic use, and islet graft failure at one year. Pediatric patients fared better, while in adults prior ERCP, multiple stents, pancreas divisum, high BMI, and low islet yield (especially <2000 IEQ/kg) were associated with increased narcotic use, persistent pain, and a 25‑fold higher risk of graft failure, underscoring the importance of islet yield.

Abstract

Our objective was to analyze factors predicting outcomes after a total pancreatectomy and islet autotransplantation (TP-IAT).Chronic pancreatitis (CP) is increasingly treated by a TP-IAT. Postoperative outcomes are generally favorable, but a minority of patients fare poorly.In our single-centered study, we analyzed the records of 581 patients with CP who underwent a TP-IAT. Endpoints included persistent postoperative "pancreatic pain" similar to preoperative levels, narcotic use for any reason, and islet graft failure at 1 year.In our patients, the duration (mean ± SD) of CP before their TP-IAT was 7.1 ± 0.3 years and narcotic usage of 3.3 ± 0.2 years. Pediatric patients had better postoperative outcomes. Among adult patients, the odds of narcotic use at 1 year were increased by previous endoscopic retrograde cholangiopancreatography (ERCP) and stent placement, and a high number of previous stents (>3). Independent risk factors for pancreatic pain at 1 year were pancreas divisum, previous body mass index >30, and a high number of previous stents (>3). The strongest independent risk factor for islet graft failure was a low islet yield-in islet equivalents (IEQ)-per kilogram of body weight. We noted a strong dose-response relationship between the lowest-yield category (<2000 IEQ) and the highest (≥5000 IEQ or more). Islet graft failure was 25-fold more likely in the lowest-yield category.This article represents the largest study of factors predicting outcomes after a TP-IAT. Preoperatively, the patient subgroups we identified warrant further attention.