*Purpose: TPIAT is utilized for intractable chronic-pancreatitis (CP).TP removes the source of pain and the addition of an islet auto transplant (IAT) minimizes the risk of brittle diabetes. Little is known about the impact of IAT on long-term islet function and quality of life (QoL). Some payers (Medicare) cover TP but do not IAT because of lack of such IAT data. The aim of this study was to evaluate the long-term impact of IAT on QoL in patients undergoing TP for CP.

*Methods: Included were patients >1 year out post- TPIAT at our center with > 1,(SF-36) completed post-TPIAT; QoL measures derived from SF-36 included PCS and MCS scores and 8 subscale scores. Patients were classified as insulin independent or dependent at time of QoL assessment, and as having islet graft function or graft failure (meal stimulated C-peptide <0.6 ng/mL). Data were analyzed using a linear mixed model with a term for on or off insulin, with a natural cubic spline basis for time since transplant to account for temporal trends, and a random subject-specific effect to account for within-person correlation. This modelling was repeated for islet graft function.

*Results: Among 815 patients who have received islet autografts at our center, 564 met criteria for inclusion with 2,161 total QOL surveys. Patients had a mean age of 33.1 years (SD 15.5 yrs, 23% children); 70% were female. Most recent QoL survey for each participant was collected at a median of 4.0 years (IQR 1.6 – 7.2 years), with 42.7% with QoL data >5 years and 17.3% with data >10 years post-TPIAT. In the linear mixed model accounting for time since transplant and within-person correlations, insulin independent patients exhibit higher QoL in every subscale domain (magnitude between 0.15-0.3 population SD scores) and for PCS and MCS (p<0.05 for all). PCS was 3.04 (SE 0.57) higher in insulin independent vs those on insulin (p<0.001). Among 429 participants who had C-peptide data, only 15% had islet graft failure as defined by endogenous C-peptide. No differences in QoL were observed by graft failure vs graft function but this may be due to inadequate power given the rarity of islet graft failure.

*Conclusions: Islet graft function is preserved long-term in the majority of TPIAT recipients. QoL is significantly higher when insulin independence is present. These data support offering IAT with TP, rather than just performing TP and treating with exogenous insulin.

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