Age and Disease Duration Impact Outcomes of Total Pancreatectomy and Islet Autotransplant for PRSS1 Hereditary Pancreatitis. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Bellin, Melena D.; Prokhoda, Polina; Hodges, James S.; Schwarzenberg, Sarah J.; Freeman, Martin L.; Dunn, Ty B.; Wilhelm, Joshua J.; Pruett, Timothy L.; Kirchner, Varvara A.; Beilman, Gregory J.; Chinnakotla, Srinath
• Is Part Of: Pancreas. Volume 47:Issue 4(2018)
• Publication Date: 2018-04
• Subjects: total pancreatectomy -- chronic pancreatitis -- acute pancreatitis -- diabetes -- hereditary pancreatitis -- PRSS1 -- TPIAT - total pancreatectomy with islet autotransplant -- PRSS1 - protease serine 1 -- HbA1c - hemoglobin A1c -- IN - islet number -- IN/kg - islet number per kilogram body weight -- IEQ - islet equivalents -- IEQ/kg - islet equivalents per kilogram body weight -- SF-36 - Short Form-36 -- MCS - mental component summary score -- PCS - physical component summary score; Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000001028
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : Objectives: We investigated the impact of patient age and disease duration on islet isolation results, diabetes outcomes, and pain outcomes after total pancreatectomy with islet autotransplant (TPIAT) performed in 64 patients with hereditary pancreatitis due to PRSS1 gene mutation. Methods: We evaluated the association of patient age and disease duration on islet isolation results and opioid use at 1 year using logistic regression and on graft function using 1-way analysis of variance. Results: Islet mass was negatively associated with increasing age and longer disease duration, with a 13% reduction (95% confidence interval [CI], 3%–22%) and 22% (95% CI, 14%–29%) reduction in islet equivalents per kilogram body weight (IEQ/kg) for each 5 years of age and disease duration, respectively. Full graft function was associated with younger age and shorter duration of disease ( P < 0.01). Persistent opioid use (15% of patients at 1 year) increased with age ( P = 0.05) and disease duration ( P = 0.04). Conclusions: The TPIAT outcomes were adversely impacted by older age and prolonged disease. In particular, islet mass is lower and risk of diabetes high in older patients with prolonged disease. This should be considered when counseling this subgroup of TPIAT recipients on expected outcomes.