Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT |
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| Affiliation: | 1. Division of Pediatric General and Thoracic Surgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;2. Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA;3. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA;4. Department of Surgery, University of Chicago, Chicago, IL, USA;5. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;6. Department of Surgery, Cleveland Clinic, OH, USA;7. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA;8. Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA;9. Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA;10. Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA;11. Department of Surgery, University of California San Francisco, San Francisco, CA, USA;12. Islet Cell Processing Laboratory, Baylor Health, Dallas, TX, USA;13. Department of Medicine, University of Louisville, Louisville, KY, USA;14. Department of Surgery, The Medical University of South Carolina, Charleston, SC, USA;15. Department of Medicine, The Ohio State Wexner University Medical Center, Columbus, OH, USA;p. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;q. Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA;r. Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;s. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;t. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA;1. Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, South Korea;2. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea;1. Division of GI Surgery, GI Oncology, Minimal Access and Bariatric Surgery, Institute of Digestive and Hepatobiliary Sciences, Medanta - the Medicity, Sector 38, Gurugram, Haryana, 122001, India;2. Division of Surgery & Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia;1. Gastrointestinal and Neuroendocrine Malignancies, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA;2. Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA;3. Liver Transplantation and Hepatopancreatobiliary Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA;4. Department of Pathology and Laboratory Medicine, 8700 Beverly Blvd., Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;1. Anhui University of Science and Technology, Huainan, 232001, China;2. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, China;3. Digestive Endoscopy Center, Shanghai Tenth People''s Hospital, Tongji University School of Medicine, Shanghai, China |
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| Abstract: | BackgroundTotal pancreatectomy with islet autotransplantation (TPIAT) is a viable option for treating debilitating recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) in adults and children. No data is currently available regarding variation in approach to operation.MethodsWe evaluated surgical techniques, islet isolation and infusion approaches, and outcomes and complications, comparing children (n = 84) with adults (n = 195) enrolled between January 2017 and April 2020 by 11 centers in the United States in the Prospective Observational Study of TPIAT (POST), which was launched in 2017 to collect standard history and outcomes data from patients undergoing TPIAT for RAP or CP.ResultsChildren more commonly underwent splenectomy (100% versus 91%, p = 0.002), pylorus preservation (93% versus 67%; p < 0.0001), Roux-en-Y duodenojejunostomy reconstruction (92% versus 35%; p < 0.0001), and enteral feeding tube placement (93% versus 63%; p < 0.0001). Median islet equivalents/kg transplanted was higher in children (4577; IQR 2816-6517) than adults (2909; IQR 1555-4479; p < 0.0001), with COBE purification less common in children (4% versus 15%; p = 0.0068). Median length of hospital stay was higher in children (15 days; IQR 14–22 versus 11 days; IQR 8–14; p < 0.0001), but 30-day readmissions were lower in children (13% versus 26%, p = 0.018). Rate of portal vein thrombosis was significantly lower in children than in adults (2% versus 10%, p = 0.028). There were no mortalities in the first 90 days post-TPIAT.ConclusionsPancreatectomy techniques differ between children and adults, with islet yields higher in children. The rates of portal vein thrombosis and early readmission are lower in children. |
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| Keywords: | Chronic pancreatitis Islet isolation Recurrent acute pancreatitis Surgical techniques Total pancreatectomy with islet autotransplantation Chronic pancreatitis" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" CP endoscopic retrograde cholangiopancreatography" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" ERCP islet equivalents per kilogram body weight" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" IEQ/kg islet number per kilogram body weight" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" IN/kg Prospective Observational Study of TPIAT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" POST recurrent acute pancreatitis" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" RAP total pancreatectomy with islet autotransplantation" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" TPIAT |
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