Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment option for chronic pancreatitis patients with refractory pain. Patients with high BMI (>30) are known to have larger pancreas with higher islet yield compared to non-obese patients. However the relationship between BMI and the outcome of TPIAT including glycemic and pain control is unknown. We analyzed the impact of preoperative BMI on the outcome of TPIAT.

Total 155 cases of TPIAT were performed during period from 2006 to 2017. Sixty six patients were analyzed after exclusion of patients with previous pancreas surgery, preoperative diabetes, and lack of data of the outcome at 1 year post operation. Patients were classified into two groups, obese patients (BMI >30, OB group, n=21) and non-obese patients (BMI<=30, NOB group, n=45) to perform statistical analysis.

Preoperative HbA1c was slightly higher in OB group (OB vs NOB; 5.6 ± 0.4 vs 5.4 ± 0.4 %, p=0.04), while preoperative pain control had no significant difference. Larger pancreas were digested in OB group (99.8 ± 20.8 vs 79.5 ± 27.0 g, p < 0.01). The islet purity before purification was significantly lower in OB group (12.1 ± 11.2 vs 25.3 ± 22.3 %, p=0.02), however the difference of purity was reduced after the purification process (40.8 ± 15.3 vs 47.0 ± 22.0 %, p=0.19). Higher mass of islets was intraportally transplanted in OB group (561,525 ± 255,539 vs 411,034 ± 190,525 IEQ, p=0.02). However OB group demonstrated slightly higher HbA1c and required higher dose of insulin at 1 year after TPIAT (HbA1c; 7.6 ± 2.7 vs 6.5 ± 1.1 %, insulin dose; 13.6 ± 15.2 vs 7.7 ±10.1 units). This suggested OB group might require more insulin than NOB group to maintain normal HbA1c level. In the pain control after TPIAT, both groups achieved the significant reduction of narcotics use, which is the primary objective of the treatment. However OB group had significantly higher pain score (pain score; 3.9 ± 3.6 vs 2.0 ±2.8), even if they used more narcotics dose.

We identified that the obese patients showed a resistance to relief from narcotic drugs even after TPIAT and that they required higher dose of insulin to control diabetes after pancreatic resection. Patient selection and treatment has to be done carefully for obese patients undergoing TPIAT for chronic pancreatitis.

CITATION INFORMATION: Yoshimatsu G., Naziruddin B., Kumano K., Fernandez H., Beecherl E., Onaca N. Obese Patients Show Resistance to Narcotics Reduction after TPIAT for Chronic Pancreatitis Am J Transplant. 2017;17 (suppl 3).

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