Medline ® Abstract for Reference 75
of 'Hereditary pancreatitis'
Long-term outcomes of total pancreatectomy and islet auto transplantation for hereditary/genetic pancreatitis.
Chinnakotla S, Radosevich DM, Dunn TB, Bellin MD, Freeman ML, Schwarzenberg SJ, Balamurugan AN, Wilhelm J, Bland B, Vickers SM, Beilman GJ, Sutherland DE, Pruett TL
J Am Coll Surg. 2014 Apr;218(4):530-43. Epub 2014 Jan 10.
BACKGROUND: Chronic pancreatitis is a debilitating disease resulting from many causes. The subset with hereditary/genetic pancreatitis (HGP) not only has chronic pain, but also an increased risk for pancreatic cancer. Long-term outcomes of total pancreatectomy (TP) and islet autogeneic transplantation (IAT) for chronic pancreatitis due to HGP are not clear.
STUDY DESIGN: We reviewed a prospectively maintained database of 484 TP-IATs from 1977 to 2012 at a single center. The outcomes (eg, pain relief, narcotic use,β-cell function, health-related quality of life measures) of patients who received TP-IAT for HGP (protease trypsin 1, n = 38; serine protease inhibitor Kazal type 1, n = 9; cystic fibrosis transmembrane conductance regulator, n = 14; and familial, n = 19) were evaluated and compared with those with non-hereditary/nongenetic causes.
RESULTS: All 80 patients with HGP were narcotic dependent and failed endoscopic management or direct pancreatic surgery. Post TP-IAT, 90% of the patients were pancreatitis pain free with sustained pain relief;>65% had partial or fullβ-cell function. Compared with nonhereditary causes, HGP patients were younger (22 years old vs 38 years old; p≤0.001), had pancreatitis pain of longer duration (11.6±1.1 years vs 9.0±0.4 years; p = 0.016), had a higher pancreas fibrosis score (7±0.2 vs 4.8±0.1; p≤0.001), and trended toward lower islet yield (3,435±361 islet cell equivalent vs 3,850±128 islet cell equivalent; p = 0.28). Using multivariate logistic regression, patients with non-HGP causes (p = 0.019); lower severity of pancreas fibrosis (p<0.001); shorter duration of years with pancreatitis (p = 0.008); and higher transplant islet cell equivalent per kilogram body weight (p≤0.001) were more likely to achieve insulin independence (p<0.001). There was a significant improvement in health-related quality of life from baseline by RAND 36-Item Short Form Health Survey and in physical and mental component health-related quality of life scores (p<0.001). None of the patients in the entire cohort had cancer of pancreatic origin in the liver or elsewhere develop during 2,936 person-years of follow-up.
CONCLUSIONS: Total pancreatectomy and IAT in patients with chronic pancreatitis due to HGP cause provide long-term pain relief (90%) and preservation ofβ-cell function. Patients with chronic painful pancreatitis due to HGP with a high lifetime risk of pancreatic cancer should be considered earlier for TP-IAT before pancreatic inflammation results in a higher degree of pancreatic fibrosis and islet cell function loss.
Department of Surgery, University of Minnesota School of Medicine, Minneapolis, MN; Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN. Electronic address: firstname.lastname@example.org.