Total pancreatectomy with islet autotransplantation- single center outcome with large cohort of patients

Introduction: Total Pancreatectomy with Islet Autologous Transplantation (TPIAT) is a promising procedure for alleviating pain and maintaining glucose homeostasis in refractory chronic pancreatitis patients who have not responded to other medical interventions. In this retrospective study, we assessed pre- and post- glycemic control in TPIAT patients as well as narcotic usage and patient-reported pain score. Methods: We performed a retrospective analysis of 200 consecutive TPIAT patients since 2006 at our center including their demographics, disease etiology, duration of disease, islet yield and quality, and pre-and post-transplant glycemic control. Patient follow-ups were performed at 3, 6, and 12 months, then continued annually. Results: Baseline patient characteristics were reported pre-transplant. The average age of TPIAT patients was 39.5 years, 39.5% male, and an average body mass index of 26.3 kg/m3. Idiopathic pancreatitis (86%) was the most common cause followed by hereditary and genetic causes (39%). Post-TPIAT insulin independence rate increased over time at 3, 6, and 12 months with 15%, 24%, and 27%, respectively. At 1 year, patient’s reported pain score significantly improved (p<0.0001). Narcotic free patients increased from 47% at 6 months to 56% at 1 year. Majority of patients preserved hypoglycemic awareness post-TPIAT. A number of patients remained normoglycemic and insulin independent. Conclusions: Compilation of patient data post-TPIAT reveals graft survival and function, and importantly, maintenance of hypoglycemic awareness in patients. TPIAT allows significant pain relief for those unresponsive to other interventions. These data support the benefits of TPIAT as a treatment option for refractory CP.