title: Quality of life improves for pediatric patients after total pancreatectomy and islet autotransplant for chronic pancreatitis.
abstract: OBJECTIVE
  Total pancreatectomy (TP) and islet autotransplant (IAT) have been used to treat patients with painful chronic pancreatitis. Initial studies indicated that most patients experienced significant pain relief, but there were few validated measures of quality of life. We investigated whether health-related quality of life improved among pediatric patients undergoing TP/IAT.
  
  
  METHODS
  Nineteen consecutive children (aged 5-18 years) undergoing TP/IAT from December 2006 to December 2009 at the University of Minnesota completed the Medical Outcomes Study 36-item Short Form (SF-36) health questionnaire before and after surgery. Insulin requirements were recorded.
  
  
  RESULTS
  Before TP/IAT, patients had below average health-related quality of life, based on data from the Medical Outcomes Study SF-36; they had a mean physical component summary (PCS) score of 30 and mental component summary (MCS) score of 34 (2 and 1.5 standard deviations, respectively, below the mean for the US population). By 1 year after surgery, PCS and MCS scores improved to 50 and 46, respectively (global effect, PCS P < .001, MCS P = .06). Mean scores improved for all 8 component subscales. More than 60% of IAT recipients were insulin independent or required minimal insulin. Patients with prior surgical drainage procedures (Puestow) had lower yields of islets (P = .01) and greater incidence of insulin dependence (P = .04).
  
  
  CONCLUSIONS
  Quality of life (physical and emotional components) significantly improve after TP/IAT in subsets of pediatric patients with severe chronic pancreatitis. Minimal or no insulin was required for most patients, although islet yield was reduced in patients with previous surgical drainage operations.
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA. bell0130@umn.edu
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.forename: Sarah Jane
authors.initials: SJ
authors.lastname: Schwarzenberg
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.forename: Selwyn M
authors.initials: SM
authors.lastname: Vickers
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: A N
authors.initials: AN
authors.lastname: Balamurugan
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Hering
authors.forename: David M
authors.initials: DM
authors.lastname: Radosevich
authors.forename: Antoinette
authors.initials: A
authors.lastname: Moran
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D008910:Minnesota; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology*; D014182:Transplantation, Autologous; D016896:Treatment Outcome