title: Long-term outcomes after total pancreatectomy and islet cell autotransplantation: is it a durable operation?
abstract: OBJECTIVE
  Total pancreatectomy and islet cell autotransplantation (TPIAT) has been increasingly utilized for the management of chronic pancreatitis (CP) with early success. However, the long-term durability of this operation remains unclear.
  
  
  METHODS
  All patients undergoing TPIAT for the treatment of CP with 5-year or greater follow-up were identified for inclusion in this single-center observational study. End points included narcotic requirements, glycemic control, islet function, quality of life (QOL), and survival.
  
  
  RESULTS
  Between 2000 and 2013, 166 patients underwent TPIAT; 112 of these patients had 5-year follow-up data to analyze. All patients underwent successful IAT with a mean of 6027 ± 595 islet equivalents per body weight. There was no perioperative mortality and actuarial survival at 5 years was 94.6%. The narcotic independence rate at 1 year was 55% and continued to improve to 73% at 5-year follow-up (P < 0.05). The insulin independence rate declined over time (38% at 1 year vs 27% at more than 5 years), but insulin requirements remained similar (21.4 vs 24.3 units per day, P = 0.6). All patients achieved stable glycemic control with a median hemoglobin A1C (HgA1C) of 6.9% (range: 5.85%-8.3%). The short form 36-item QOL assessment of a subset of patients available for contact demonstrated continued improvements in all tested modules in patients with at least 5-year follow-up. Two patients developed diabetic complications requiring whole organ pancreas transplant for salvage.
  
  
  CONCLUSIONS
  This represents one of the largest series examining long-term outcomes after TPIAT. This operation produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, but most patients maintain stable glycemic control.
authors.affiliation: Departments of *Surgery †Gastroenterology ‡Endocrinology §Radiology, University of Cincinnati Medical Center ¶Department of Surgery, University of California San Diego School of Medicine ‖Department of Surgery, University of Chicago Medical Center; and **Department of Surgery, University of Arizona Medical Center.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Milton T
authors.initials: MT
authors.lastname: Smith
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Lowy
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Matthews
authors.forename: Horacio L R
authors.initials: HL
authors.lastname: Rilo
authors.forename: Nathan
authors.initials: N
authors.lastname: Schmulewitz
authors.forename: Marzieh
authors.initials: M
authors.lastname: Salehi
authors.forename: Kyuran
authors.initials: K
authors.lastname: Choe
authors.forename: John
authors.initials: J
authors.lastname: Brunner
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D009294:Narcotics