Correlation of pancreatic histopathologic findings and islet yield in children with chronic pancreatitis undergoing total pancreatectomy and islet autotransplantation.
OBJECTIVE
The probability of insulin independence after intraportal islet autotransplantation (IAT) for chronic pancreatitis (CP) treated by total pancreatectomy (TP) relates to the number of islets isolated from the excised pancreas. Our goal was to correlate the islet yield with the histopathologic findings and the clinical parameters in pediatric (age, <19 years) CP patients undergoing TP-IAT.


METHODS
Eighteen pediatric CP patients aged 5 to 18 years (median, 15.6 years) who underwent TP-IAT were studied. Demographics and clinical history came from medical records. Histopathologic specimens from the pancreas were evaluated for presence and severity of fibrosis, acinar cell atrophy, inflammation, and nesidioblastosis by a surgical pathologist blinded to clinical information.


RESULTS
Fibrosis and acinar atrophy negatively correlated with islet yield (P = 0.02, r = -0.50), particularly in hereditary CP (P = 0.01). Previous duct drainage surgeries also had a strong negative correlation (P = 0.01). Islet yield was better in younger (preteen) children (P = 0.02, r = -0.61) and in those with pancreatitis of shorter duration (P = 0.04, r = -0.39).


CONCLUSIONS
For preserving beta cell mass, it is best to perform TP-IAT early in the course of CP in children, and prior drainage procedures should be avoided to maximize the number of islets available, especially in hereditary disease.
Kobayashi
Takashi
T
Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
Manivel
Juan C
JC
Bellin
Melena D
MD
Carlson
Annelisa M
AM
Moran
Antoinette
A
Freeman
Martin L
ML
Hering
Bernhard J
BJ
Sutherland
David E R
DE
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D046768:Nesidioblastosis / Q000473:pathology; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000473:pathology / Q000601:surgery*