title: Predicting islet yield in pediatric patients undergoing pancreatectomy and autoislet transplantation for chronic pancreatitis.
abstract: 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.
authors.affiliation: Department of Pediatrics, University of Minnesota, 420 Delaware Street, Minneapolis, MN 55455, USA. bell0130@umn.edu
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Blondet
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: A N
authors.initials: AN
authors.lastname: Balamurugan
authors.forename: William
authors.initials: W
authors.lastname: Thomas
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: Antoinette
authors.initials: A
authors.lastname: Moran
mesh_terms: 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
chemical_list: 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