Predicting islet yield in pediatric patients undergoing pancreatectomy and autoislet transplantation for chronic pancreatitis.
OBJECTIVE
Chronic pancreatitis (CP) in children is associated with significant morbidity and can lead to narcotic dependence. Total pancreatectomy (TP) may be indicated in refractory CP to relieve pain; simultaneous islet autotransplant (IAT) may prevent postsurgical diabetes. About half of pediatric patients are insulin independent 1 yr after IAT. Insulin independence correlates best with the number of islets available for transplantation (islet yield). Currently there is no known method to predict islet yield in a given patient. We assessed the ability of preoperative metabolic tests to predict islet yields in 10 children undergoing TP/IAT.


METHODS
Hemoglobin A1c (HbA(1c)) and mixed meal tolerance tests (MMTT) were obtained prior to surgery in 10 patients age <or= 18 yr. Fasting glucose, C-peptide, and creatinine were used to calculate the C-peptide to glucose* creatinine ratio (CPGCR). C-peptide peak and area under the curve (AUC) were determined from 2 h MMTT. Linear regressions were performed to predict islet yield from baseline test results.


RESULTS
Islet yield ranged from 7000 to 434 000 islet equivalents (IE) (mean 222 452 +/- 148 697 IE). Islet yield was well predicted from body weight and fasting plasma glucose (R (2) = 57%, adjusted for overfitting by bootstrap). Islet yield was positively associated with CPGCR, peak C-peptide, and AUC C-peptide and negatively associated with HbA(1c).


CONCLUSIONS
Pilot data from 10 pediatric patients suggest that simple preoperative measurement of fasting plasma glucose may give a useful prediction of islet yield. Islet yield correlates with HbA(1c) and C-peptide levels. This information allows individual candidates to weigh the specific risk of becoming diabetic against the benefit of pain relief should they undergo TP-IAT.
Bellin
Melena D
MD
Department of Pediatrics, University of Minnesota, 420 Delaware Street, Minneapolis, MN 55455, USA. bell0130@umn.edu
Blondet
Juan J
JJ
Beilman
Gregory J
GJ
Dunn
Ty B
TB
Balamurugan
A N
AN
Thomas
William
W
Sutherland
David E R
DE
Moran
Antoinette
A
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics; D003922:Diabetes Mellitus, Type 1 / Q000517:prevention & control; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007515:Islets of Langerhans; D016381:Islets of Langerhans Transplantation; D008297:Male; D010148:Intractable Pain / Q000601:surgery; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014357:Trypsin / Q000235:genetics; D014359:Trypsin Inhibitor, Kazal Pancreatic
D001786:Blood Glucose; D002096:C-Peptide; D002352:Carrier Proteins; D003404:Creatinine; D019005:Cystic Fibrosis Transmembrane Conductance Regulator; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D014357:Trypsin; D014359:Trypsin Inhibitor, Kazal Pancreatic; C505032:CFTR protein, human; C486642:SPINK1 protein, human; C517652:hemoglobin A1c protein, human; C489303:PRSS1 protein, human