Islet autotransplant outcomes in thirty-six children undergoing pancreatectomy and islet autotransplant

M. Bellin¹, A. Moran², B.J. Hering¹, S. Chinnakotla², A.N. Balamurugan¹, T.B. Dunn², G.J. Beilman², D.E.R. Sutherland^1
1 University of Minnesota, Schulze Diabetes Institute, Minneapolis, USA; ² University of Minnesota, Minneapolis, USA

Background: The procedure of total pancreatectomy (TP) and islet autotransplant (IAT) to treat chronic pancreatitis is rarely performed in children. We reviewed TPIAT outcomes in a large cohort (n=36) of children undergoing this procedure, to better describe outcomes and identify favorable prognostic factors.

Methods: 42 patients (age 5-18 years) underwent TPIAT at a single center from 1989-2009. Follow up data was available for 36. Insulin use and hemoglobin A1c (HbA1c) were obtained from medical records and/or health questionnaires administered to patients/parents. Patients were classified as insulin independent (fasting blood sugar<126 mg/dL and HbA1c <6.5% without exogenous insulin), minimally insulin dependent (basal analog or rare correction scale alone), or fully insulin dependent (multiple injections/day).

Results: Patients underwent pancreatectomy at a mean age of 13.6±4.0 years and received 4,444 ± 3,461 islet equivalents per kilogram body weight (IE/kg). Eleven had a history of distal pancreatectomy (n=3), lateral pancreaticojejunostomy(n=5), or both(n=3). Patients were 3.0 ± 3.2 years posttransplant at follow up. In all, 16 patients maintained insulin independence, 7 had minimal insulin requirements, and 13 patients were fully insulin dependent. HbA1c was consistently <6.5% for all patients requiring no or minimal insulin. HbA1c was variable in fully insulin dependent patients, ranging from 5.6- 12.1%. Factors associated with better islet transplant outcomes included younger age at transplant(p=0.04), greater IE/kg transplanted(p=0.002), and lack of prior distal pancreatectomy or lateral pancreaticojejunostomy(p=0.0003). Notably, none of the 11 patients with a prior distal pancreatectomy or pancreaticojejunostomy had sustained insulin independence. There was a trend towards better outcomes in those with a shorter duration of disease (p=0.08).

Conclusions: Overall, 45% of children achieved and maintained insulin independence after IAT, while ~20% required minimal insulin to maintain euglycemia. Prior partial pancreatic resections (without IAT) and surgical drainage procedures conferred a particularly poor prognosis.