Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT: Surgical Approaches in Total Pancreatectomy with Islet Autotransplantation

Jaimie D. Nathan, Yi Yang, Anne Eaton, Piotr Witkowski, Martin Wijkstrom, Matthew Walsh, Guru Trikudanathan, Vikesh K. Singh, Sarah J. Schwarzenberg, Timothy L. Pruett, Andrew Posselt, Bashoo Naziruddin, Sri Prakash Mokshagundam, Katherine Morgan, Luis F. Lara, Varvara Kirchner, Jin He, Timothy B. Gardner, Martin L. Freeman, Kate ElleryDarwin L. Conwell, Srinath Chinnakotla, Gregory J. Beilman, Syed Ahmad, Maisam Abu-El-Haija, James S. Hodges, Melena D. Bellin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Total pancreatectomy with islet autotransplantation (TPIAT) is a viable option for treating debilitating recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) in adults and children. No data is currently available regarding variation in approach to operation. Methods: We evaluated surgical techniques, islet isolation and infusion approaches, and outcomes and complications, comparing children (n = 84) with adults (n = 195) enrolled between January 2017 and April 2020 by 11 centers in the United States in the Prospective Observational Study of TPIAT (POST), which was launched in 2017 to collect standard history and outcomes data from patients undergoing TPIAT for RAP or CP. Results: Children more commonly underwent splenectomy (100% versus 91%, p = 0.002), pylorus preservation (93% versus 67%; p < 0.0001), Roux-en-Y duodenojejunostomy reconstruction (92% versus 35%; p < 0.0001), and enteral feeding tube placement (93% versus 63%; p < 0.0001). Median islet equivalents/kg transplanted was higher in children (4577; IQR 2816-6517) than adults (2909; IQR 1555-4479; p < 0.0001), with COBE purification less common in children (4% versus 15%; p = 0.0068). Median length of hospital stay was higher in children (15 days; IQR 14–22 versus 11 days; IQR 8–14; p < 0.0001), but 30-day readmissions were lower in children (13% versus 26%, p = 0.018). Rate of portal vein thrombosis was significantly lower in children than in adults (2% versus 10%, p = 0.028). There were no mortalities in the first 90 days post-TPIAT. Conclusions: Pancreatectomy techniques differ between children and adults, with islet yields higher in children. The rates of portal vein thrombosis and early readmission are lower in children.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalPancreatology
Volume22
Issue number1
DOIs
StatePublished - Jan 2022

Bibliographical note

Funding Information:
Source of Funding: Prospective Observational Study of TPIAT (POST) consortium, supported by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK, R01-DK109124 , PI Melena Bellin).

Funding Information:
MDB discloses the following: research support from Viacyte and Dexcom; advisory role (DSMB) for Insulet. LFL discloses the following: research support from Abbvie, consultant for Abbvie, speaker for Abbvie and Nestle. SJS discloses funding from Gilead and UpToDate. VKS is a consultant for Abbvie and Nestle, and he receives research support from Orgenesis and Theraly.

Publisher Copyright:
© 2021 IAP and EPC

Keywords

  • Chronic pancreatitis
  • Islet isolation
  • Recurrent acute pancreatitis
  • Surgical techniques
  • Total pancreatectomy with islet autotransplantation

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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