Outcome after pancreatectomy and islet autotransplantation in a pediatric population.
OBJECTIVE
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.


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.
Bellin
Melena D
MD
Department of Pediatrics, Division of Endocrinology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, USA. bell0130@umn.edu
Carlson
Annelisa M
AM
Kobayashi
Takashi
T
Gruessner
Angelika C
AC
Hering
Bernhard J
BJ
Moran
Antoinette
A
Sutherland
David E R
DE
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation; D008297:Male; D010148:Intractable Pain / Q000628:therapy; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin