Date: Monday, May 1, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: There is a group of Total pancreatectomy (TP) is offered as a last option to patients with chronic pancreatitis (CP) who despite optimal treatment develop intractable pain leading to narcotic dependence, malnutrition and poor quality of life (QoL). Islet autotransplantation (IAT) was developed to improve glucose control and prevent diabetes enhancing QoL.
Methods: We analyzed results in 14 patients, who had exhausted all medical and surgical interventions and underwent a TPIAT at our center.
Results. In 8/14 (60%) patients, a genetic mutation was driving chronic inflammation and progression of symptoms. Patients suffered from CP for 9.5 years (3-39). They had multiple endoscopic or surgical procedures 4 (2-15), with an average of 4 acute pancreatitis attacks per year. Chronic pain- median 9.5 in Visual Analogue Score (VAS) was reported, which led to chronic narcotics use in all patients for 7.5 (1-110) months prior to TPIAT in amount of 52 (5-240) morphine equivalent doses (MED). However, it allowed only partial pain relief (median VAS of 4.5). 70% of patients required pancreatic enzyme supplementation (PES) and one of them insulin support prior to surgery. During TPIAT patients received on average 211,000 (76,600-379,000) islet equivalents infused via portal vein. On day 75 follow up, 50% of patients were insulin free with A1c<6.5. Remaining presented good glucose control with insulin (0.07-0.17U/kg), and median A1c 6.2. At the same time, 6 patients were able to completely wean off narcotics. Remaining required lower dose- 37.5 (10-130) MED. All patients denied diarrhea or steatorrhea after adjusted PES. At 1-year evaluation, 6 of 7 (86%) patients remained insulin free with A1c 6.25 and the rest had good glucose control with A1c 7.3. All patients expressed overall improvement in pain control and QoL. Prior the TPIAT, physical health based on SF36 questionnaire was compromised to 25%, which improved to 33% on day 75,and 44% on 1 year. Mental health was 44.3 %, improved to 51% on day 75, and 1 year to 53%.
Conclusion: TPIAT allows improving QoL with pain resolution and good glucose control in patients suffering from CP and intractable pain.
CITATION INFORMATION: Kotukhov A, Solomina J, Konsur E, Cieply K, Basto L, Wang L.-J, Golab K, Tibudan M, Gelrud A, Thomas C, Matthews J, Witkowski P. Total Pancreatectomy with Islet Autotransplantation Improves Quality of Life Allowing for the Resolution of the Intractable Pain with Good Glucose Control in Properly Selected Patients with Chronic Pancreatitis. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Kotukhov A, Solomina J, Konsur E, Cieply K, Basto L, Wang L-J, Golab K, Tibudan M, Gelrud A, Thomas C, Matthews J, Witkowski P. Total Pancreatectomy with Islet Autotransplantation Improves Quality of Life Allowing for the Resolution of the Intractable Pain with Good Glucose Control in Properly Selected Patients with Chronic Pancreatitis. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/total-pancreatectomy-with-islet-autotransplantation-improves-quality-of-life-allowing-for-the-resolution-of-the-intractable-pain-with-good-glucose-control-in-properly-selected-patients-with-chronic-pa/. Accessed September 29, 2020.
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