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Isolation of Human Islets from Partially Pancreatectomized Patients
Published on: July 30, 2011
Outcome after pancreatectomy and islet autotransplantation in a pediatric population
Melena D Bellin1, Annelisa M Carlson, Takashi Kobayashi
1Department of Pediatrics, Division of Endocrinology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, USA. bell0130@umn.edu
Insights
Pancreatectomy with islet autotransplantation effectively manages pain and metabolic issues in pediatric chronic pancreatitis patients. Younger children experienced better outcomes, with reduced narcotic dependence and improved graft function.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Gastroenterology
Background:
- Chronic pancreatitis in children poses significant challenges for pain management and metabolic control.
- Pancreatectomy with islet autotransplantation is a complex procedure with limited data on long-term outcomes in pediatric populations.
Purpose of the Study:
- To evaluate pain control and metabolic outcomes in pediatric patients after pancreatectomy and islet autotransplantation.
- To compare outcomes between preadolescent and adolescent patients undergoing the procedure.
Main Methods:
- Retrospective review of 24 pediatric patients (≤18 years) undergoing pancreatectomy and islet autotransplantation.
- Follow-up via telephone survey assessing narcotic and insulin use.
- Comparison of outcomes based on age at surgery (preadolescents vs. adolescents).
Main Results:
- 39% of patients discontinued narcotics post-surgery.
- 78% achieved islet graft function within 1 year, with 56% insulin-independent.
- Higher islet yield and no prior pancreatic surgery predicted insulin independence.
- Preadolescents showed better pain control and graft function compared to adolescents.
Conclusions:
- Pancreatectomy and islet autotransplantation can successfully alleviate pain and mitigate diabetes in pediatric chronic pancreatitis.
- The majority of pediatric patients can discontinue narcotic use.
- Younger children generally achieve superior outcomes with this combined surgical approach.
Objectives:
Little is known regarding outcomes after pancreatectomy and islet autotransplantation for chronic pancreatitis in pediatric patients. In this study, we document pain control and metabolic course after this procedure in a pediatric population.
Materials And Methods:
We reviewed medical records for 24 patients 18 years old or younger who underwent pancreatectomy with islet autotransplantation at the University of Minnesota from July 1989 through June 2006. Patients and/or their parents were invited to participate in a follow-up telephone survey. Primary outcome measures were narcotics and insulin use at follow-up. We compared outcomes in patients undergoing surgery as preadolescents (<13 years old) versus adolescents.
Results:
Follow-up information was available on 18 of 24 patients. All of the patients required narcotics before surgery. Of the 18, only 7 (39%) were still taking narcotics at the time of the survey. At 1 year posttransplant, 78% of patients had islet graft function with full function (insulin independent) in 56% and partial function (once-daily insulin use only) in 22%. By Cox regression analysis, important predictors of insulin independence were islet yield >2000 islet equivalents per kilogram and lack of prior pancreatic surgery (P = 0.011). Preadolescents were less likely to require chronic narcotic therapy at follow-up (P = 0.05) and were more likely to maintain graft function (P = 0.02) compared with adolescents.
Conclusions:
Pancreatectomy can relieve pain in pediatric patients with chronic pancreatitis and the majority can withdraw from narcotics. Islet autotransplantation can prevent or reduce the severity of diabetes in about three fourths of patients. Outcome goals were reached in a higher proportion of younger than older children.
