title: Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes.
abstract: OBJECTIVE
  Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients.
  
  
  BACKGROUND
  Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes.
  
  
  METHODS
  Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012.
  
  
  RESULTS
  Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P < 0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (P = 0.032), lack of prior Puestow procedure (P = 0.018), lower body surface area (P = 0.048), higher islet equivalents (IEQ) per kilogram body weight (P = 0.001), and total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT: (1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P < 0.001).
  
  
  CONCLUSIONS
  Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.
authors: Departments of *Surgery and †Pediatrics ‡Schulze Diabetes Institute §Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
authors: Srinath
authors: S
authors: Chinnakotla
authors: Melena D
authors: MD
authors: Bellin
authors: Sarah J
authors: SJ
authors: Schwarzenberg
authors: David M
authors: DM
authors: Radosevich
authors: Marie
authors: M
authors: Cook
authors: Ty B
authors: TB
authors: Dunn
authors: Gregory J
authors: GJ
authors: Beilman
authors: Martin L
authors: ML
authors: Freeman
authors: A N
authors: AN
authors: Balamurugan
authors: Josh
authors: J
authors: Wilhelm
authors: Barbara
authors: B
authors: Bland
authors: Jose M
authors: JM
authors: Jimenez-Vega
authors: Bernhard J
authors: BJ
authors: Hering
authors: Selwyn M
authors: SM
authors: Vickers
authors: Timothy L
authors: TL
authors: Pruett
authors: David E R
authors: DE
authors: Sutherland
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010147:Pain Measurement; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome