Abstract

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.

Highlights

  • Chronic pancreatitis (CP) is a progressive disease that is characterized by inflammation and fibrosis of the pancreas eventually leading to endocrine and exocrine dysfunction along with significant morbidity and mortality [1]

  • We identified a total of 13 patients that met the criteria to undergo Total pancreatectomy and islet autotransplantation (TPIAT) between 9-2013 and 9-2018

  • 61.5% were women, which is consistent with overall female dominant prevalence of chronic pancreatitis

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Summary

Introduction

Chronic pancreatitis (CP) is a progressive disease that is characterized by inflammation and fibrosis of the pancreas eventually leading to endocrine and exocrine dysfunction along with significant morbidity and mortality [1]. The incidence of CP is estimated to range from 5 to 14 per 100,000 individuals with a prevalence of 30-50 per 100,000 individuals in most countries, while some countries have noted prevalence as high as 20-125/100,000 [1]. The incidence has been increasing over the past couple of decades based on various population studies worldwide [1]. CP is a debilitating disease; its morbidity and mortality is associated with eventual loss of endocrine function leading to secondary diabetes, along with gastrointestinal malabsorption. Journal of Diabetes Research due to loss of exocrine function as the disease progresses [2]. 90% of patients with CP suffer from refractory pain with a 20-25-year mortality of approximately 50% [2, 3]

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