title: Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases.
abstract: OBJECTIVE
  Our objective was to analyze factors predicting outcomes after a total pancreatectomy and islet autotransplantation (TP-IAT).
  
  
  BACKGROUND
  Chronic pancreatitis (CP) is increasingly treated by a TP-IAT. Postoperative outcomes are generally favorable, but a minority of patients fare poorly.
  
  
  METHODS
  In our single-centered study, we analyzed the records of 581 patients with CP who underwent a TP-IAT. Endpoints included persistent postoperative "pancreatic pain" similar to preoperative levels, narcotic use for any reason, and islet graft failure at 1 year.
  
  
  RESULTS
  In our patients, the duration (mean ± SD) of CP before their TP-IAT was 7.1 ± 0.3 years and narcotic usage of 3.3 ± 0.2 years. Pediatric patients had better postoperative outcomes. Among adult patients, the odds of narcotic use at 1 year were increased by previous endoscopic retrograde cholangiopancreatography (ERCP) and stent placement, and a high number of previous stents (>3). Independent risk factors for pancreatic pain at 1 year were pancreas divisum, previous body mass index >30, and a high number of previous stents (>3). The strongest independent risk factor for islet graft failure was a low islet yield-in islet equivalents (IEQ)-per kilogram of body weight. We noted a strong dose-response relationship between the lowest-yield category (<2000 IEQ) and the highest (≥5000 IEQ or more). Islet graft failure was 25-fold more likely in the lowest-yield category.
  
  
  CONCLUSIONS
  This article represents the largest study of factors predicting outcomes after a TP-IAT. Preoperatively, the patient subgroups we identified warrant further attention.
authors.affiliation: *Department of Surgery, University of Minnesota Medical School, Minneapolis, MN †Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN ‡Schulze Diabetes Institute, University of Minnesota Medical School, Minneapolis, MN §Department of Medicine, University of Minnesota Medical School, Minneapolis, MN ¶Pain Management, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.forename: David M
authors.initials: DM
authors.lastname: Radosevich
authors.forename: Mustafa
authors.initials: M
authors.lastname: Arain
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Amateau
authors.forename: J Shawn
authors.initials: JS
authors.lastname: Mallery
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schwarzenberg
authors.forename: Alfred
authors.initials: A
authors.lastname: Clavel
authors.forename: Joshua
authors.initials: J
authors.lastname: Wilhelm
authors.forename: R Paul
authors.initials: RP
authors.lastname: Robertson
authors.forename: Louise
authors.initials: L
authors.lastname: Berry
authors.forename: Marie
authors.initials: M
authors.lastname: Cook
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Hering
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics