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Published on: July 30, 2011
Total Pancreatectomy With Islet Autotransplantation Resolves Pain in Young Children With Severe Chronic Pancreatitis
Melena D Bellin1, Gregory P Forlenza, Kaustav Majumder
1*Department of Pediatrics†Department of Surgery‡Department of Radiology§Department of Medicine, University of Minnesota and Masonic Children's Hospital, Minneapolis, MN¶Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO.
Insights
Total pancreatectomy with islet autotransplant (TPIAT) offers significant pain relief and improved quality of life for young children with severe pancreatitis. This procedure leads to high rates of insulin independence and excellent glycemic control in this pediatric population.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Endocrinology
Background:
- Severe pancreatitis in young children poses significant challenges, often leading to chronic pain and dependence on pain medication.
- Fear of major surgery and potential diabetes complications can limit treatment options like total pancreatectomy with islet autotransplant (TPIAT).
Purpose of the Study:
- To evaluate the outcomes of TPIAT in very young children (3-8 years old) with severe, refractory chronic pancreatitis.
- To assess pain relief, narcotic use, hospitalization rates, insulin independence, and glycemic control post-TPIAT in this pediatric cohort.
Main Methods:
- Retrospective review of 17 children (≤8 years) who underwent TPIAT between 2000 and 2014.
- Prospective follow-up since 2006 included pain and narcotic use assessments, HbA1c, and mixed-meal tolerance tests.
- Analysis of outcomes up to 11 years post-TPIAT (median 2.2 years).
Main Results:
- All 17 patients experienced pain relief and discontinued narcotics post-TPIAT.
- Hospitalizations decreased significantly from 5.0 to 0.35 episodes per person-year.
- Insulin independence was achieved in 82% of patients, significantly higher than the 41% rate in older children (P=0.004).
- Median post-TPIAT HbA1c was 5.9%, with most patients maintaining glycemic control (≤6.5%).
Conclusions:
- TPIAT is a viable and effective treatment for young children suffering from severe, refractory chronic pancreatitis.
- The procedure demonstrates high success rates in pain management, narcotic cessation, and achieving insulin independence.
- Excellent glycemic control is achievable in the majority of these young TPIAT recipients.
Objectives:
Fear of diabetes and major surgery may prohibit referral of young children severely affected by pancreatitis for total pancreatectomy with islet autotransplant (TPIAT). We evaluated outcomes in our youngest TPIAT recipients, 3 to 8 years of age at surgery.
Methods:
Medical records were reviewed for 17 children (9 girls) ages 8 years or younger undergoing TPIAT from 2000 to 2014. Most (14/17) had genetic risk factors for pancreatitis. Since 2006, TPIAT recipients were followed prospectively with health questionnaires including assessments of pain and narcotic use, and scheduled hemoglobin A1c (HbA1c) and mixed-meal tolerance tests (6 mL/kg Boost HP) before surgery, and at regular intervals after. Patients are 1 to 11 years post-TPIAT (median 2.2 years). Data are reported as median (25th, 75th percentile).
Results:
All had relief of pain, with all 17 patients off narcotics at most recent follow-up. Hospitalization rates decreased from 5.0 hospitalization episodes per person-year of follow-up before TPIAT, to 0.35 episodes per person-year of follow-up after TPIAT. Fourteen (82%) discontinued insulin, higher than the observed insulin independence rate of 41% in 399 patients older than 8 years of age undergoing TPIAT over the same interval (P = 0.004). Median post-TPIAT HbA1c was 5.9% (5.6%, 6.3%), and within patient post-TPIAT mean HbA1c was ≤6.5% for all but 2 patients.
Conclusions:
Young children with severe refractory chronic pancreatitis may be good candidates for TPIAT, with high rates of pain relief and insulin independence, and excellent glycemic control in the majority.
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