*Purpose: Total pancreatectomy and islet autotransplantation (TPIAT) for patients with uncontrolled chronic pancreatitis has been performed at our center from 2006 and the number of TPIAT patient has reached 200 in 2020. We have attempted to improve the transplant outcome over time using novel anti-inflammatory treatment regimen utilizing combined use of anakinra (IL-1β blocker) and etanercept (a tumor necrosis factor-alpha (TNF-α) blocker). It is still challenging to standardize our procedure and predict outcomes after TPIAT. Therefore, we retrospectively reviewed our large data of islet isolation results and metabolic outcome in order to contribute to making further progress with TPIAT.

*Methods: Our database of 200 consecutive TPIAT procedures performed between 2006 and 2020 were retrospectively reviewed. We collected the data of baseline demographics, pancreas characteristics and islet isolation results. Patient follow-up were performed at 3 and 6 months, 1 year, and then annually. Our outcomes measures included islet graft function, pain relief and narcotic use.

*Results: Baseline patient characteristics (age, sex, BMI, etiology, pretransplant C-peptide and hemoglobin (Hb) A1c levels, duration of symptoms) and isolation results were shown in Table 1. Post-operative non-fasting glucose, HbA1c level, C-peptide level and the average daily insulin requirement were shown in Table 2. The insulin independence rate at 3, 6 and 1 year increased with time (15.4%, 24.0% and 26.7%, respectively), comparable results reported previously. At 1 year, pain score was significantly improved (pre: 6.1±2.7, 1year: 2.4±2.9, p<0.0001). Narcotic free rate also increased with time: the rates were 47% at 6 months and 56% at 1 year.

*Conclusions: In our cohort of 200 patients, we showed that TPIAT effectively alleviated pain due to chronic pancreatitis. TPIAT has beneficial effect on pain relief and decrease of narcotic use. Although nearly 27% of our patients had achieved insulin independence at 1 year, further progress of islet autotransplantation procedure would be necessary to improve and maintain long term islet graft function after TPIAT.

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