TY - JOUR
T1 - Outcome after pancreatectomy and islet autotransplantation in a pediatric population
AU - Bellin, Melena D.
AU - Carlson, Annelisa M.
AU - Kobayashi, Takashi
AU - Gruessner, Angelika C.
AU - Hering, Bernhard J.
AU - Moran, Antoinette
AU - Sutherland, David E.R.
PY - 2008/7
Y1 - 2008/7
N2 - Objectives: Little is known regarding outcomes after pancreatectomy and islet autotransplantation for chronic pancreatitis in pediatric patients. In this study, we document pain control and metabolic course after this procedure in a pediatric population. Materials and Methods: We reviewed medical records for 24 patients 18 years old or younger who underwent pancreatectomy with islet autotransplantation at the University of Minnesota from July 1989 through June 2006. Patients and/or their parents were invited to participate in a follow-up telephone survey. Primary outcome measures were narcotics and insulin use at follow-up. We compared outcomes in patients undergoing surgery as preadolescents (<13 years old) versus adolescents. Results: Follow-up information was available on 18 of 24 patients. All of the patients required narcotics before surgery. Of the 18, only 7 (39%) were still taking narcotics at the time of the survey. At 1 year posttransplant, 78% of patients had islet graft function with full function (insulin independent) in 56% and partial function (once-daily insulin use only) in 22%. By Cox regression analysis, important predictors of insulin independence were islet yield >2000 islet equivalents per kilogram and lack of prior pancreatic surgery (P=0.011). Preadolescents were less likely to require chronic narcotic therapy at follow-up (P=0.05) and were more likely to maintain graft function (P=0.02) compared with adolescents. Conclusions: Pancreatectomy can relieve pain in pediatric patients with chronic pancreatitis and the majority can withdraw from narcotics. Islet autotransplantation can prevent or reduce the severity of diabetes in about three fourths of patients. Outcome goals were reached in a higher proportion of younger than older children.
AB - Objectives: Little is known regarding outcomes after pancreatectomy and islet autotransplantation for chronic pancreatitis in pediatric patients. In this study, we document pain control and metabolic course after this procedure in a pediatric population. Materials and Methods: We reviewed medical records for 24 patients 18 years old or younger who underwent pancreatectomy with islet autotransplantation at the University of Minnesota from July 1989 through June 2006. Patients and/or their parents were invited to participate in a follow-up telephone survey. Primary outcome measures were narcotics and insulin use at follow-up. We compared outcomes in patients undergoing surgery as preadolescents (<13 years old) versus adolescents. Results: Follow-up information was available on 18 of 24 patients. All of the patients required narcotics before surgery. Of the 18, only 7 (39%) were still taking narcotics at the time of the survey. At 1 year posttransplant, 78% of patients had islet graft function with full function (insulin independent) in 56% and partial function (once-daily insulin use only) in 22%. By Cox regression analysis, important predictors of insulin independence were islet yield >2000 islet equivalents per kilogram and lack of prior pancreatic surgery (P=0.011). Preadolescents were less likely to require chronic narcotic therapy at follow-up (P=0.05) and were more likely to maintain graft function (P=0.02) compared with adolescents. Conclusions: Pancreatectomy can relieve pain in pediatric patients with chronic pancreatitis and the majority can withdraw from narcotics. Islet autotransplantation can prevent or reduce the severity of diabetes in about three fourths of patients. Outcome goals were reached in a higher proportion of younger than older children.
KW - Autologous islet cell transplant
KW - Chronic pancreatitis
KW - Islet autotransplant
KW - Pancreatectomy
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U2 - 10.1097/MPG.0b013e31815cbaf9
DO - 10.1097/MPG.0b013e31815cbaf9
M3 - Article
C2 - 18607267
AN - SCOPUS:55549140546
SN - 0277-2116
VL - 47
SP - 37
EP - 44
JO - Journal of pediatric gastroenterology and nutrition
JF - Journal of pediatric gastroenterology and nutrition
IS - 1
ER -