World J Transplant. 2016 Mar 24;6(1):233-8. doi: 10.5500/wjt.v6.i1.233.
Total pancreatectomy and islet autotransplantation: A decade nationwide analysis.
World journal of transplantation
Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii
Affiliations
Affiliations
- Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA 92868, United States.
PMID: 27011922
PMCID: PMC4801800 DOI: 10.5500/wjt.v6.i1.233
Abstract
AIM: To investigate outcomes and predictors of in-hospital morbidity and mortality after total pancreatectomy (TP) and islet autotransplantation.
METHODS: The nationwide inpatient sample (NIS) database was used to identify patients who underwent TP and islet autotransplantation (IAT) between 2002-2012 in the United States. Variables of interest were inherent variables of NIS database which included demographic data (age, sex, and race), comorbidities (such as diabetes mellitus, hypertension, and deficiency anemia), and admission type (elective vs non-elective). The primary endpoints were mortality and postoperative complications according to the ICD-9 diagnosis codes which were reported as the second to 25(th) diagnosis of patients in the database. Risk adjusted analysis was performed to investigate morbidity predictors. Multivariate regression analysis was used to identify predictors of in-hospital morbidity.
RESULTS: We evaluated a total of 923 patients who underwent IAT after pancreatectomy during 2002-2012. Among them, there were 754 patients who had TP + IAT. The most common indication of surgery was chronic pancreatitis (86%) followed by acute pancreatitis (12%). The number of patients undergoing TP + IAT annually significantly increased during the 11 years of study from 53 cases in 2002 to 155 cases in 2012. Overall mortality and morbidity of patients were 0% and 57.8 %, respectively. Post-surgical hypoinsulinemia was reported in 42.3% of patients, indicating that 57.7% of patients were insulin independent during hospitalization. Predictors of in-hospital morbidity were obesity [adjusted odds ratio (AOR): 3.02, P = 0.01], fluid and electrolyte disorders (AOR: 2.71, P < 0.01), alcohol abuse (AOR: 2.63, P < 0.01), and weight loss (AOR: 2.43, P < 0.01).
CONCLUSION: TP + IAT is a safe procedure with no mortality, acceptable morbidity, and achieved high rate of early insulin independence. Obesity is the most significant predictor of in-hospital morbidity.
Keywords: Chronic pancreatitis; Insulin independency; Islet auto transplantation; Pancreatectomy; Total pancreatectomy
References
- Curr Surg. 2003 Jul-Aug;60(4):463-9 - PubMed
- Pancreas. 2008 Oct;37(3):282-7 - PubMed
- Am Fam Physician. 2007 Dec 1;76(11):1679-88 - PubMed
- HPB (Oxford). 2009 Dec;11(8):613-21 - PubMed
- Cell Transplant. 2011;20(2):313-22 - PubMed
- J Am Coll Surg. 2012 Apr;214(4):409-24; discussion 424-6 - PubMed
- World J Surg. 2003 Nov;27(11):1175-82 - PubMed
- BMC Anesthesiol. 2015 Jul 31;15:112 - PubMed
- J Am Coll Surg. 2005 Nov;201(5):680-7 - PubMed
- Am Surg. 2008 Jun;74(6):530-6; discussion 536-7 - PubMed
- Pancreas. 2009 Jan;38(1):1-7 - PubMed
- J Pediatr Gastroenterol Nutr. 2008 Jul;47(1):37-44 - PubMed
- Surg Clin North Am. 2007 Dec;87(6):1477-501, x - PubMed
- Ann Surg. 1995 Oct;222(4):562-75; discussion 575-9 - PubMed
- Transplantation. 2008 Dec 27;86(12):1799-802 - PubMed
- Hepatobiliary Pancreat Dis Int. 2006 Feb;5(1):133-7 - PubMed
- Pancreas. 2007 Jul;35(1):1-15 - PubMed
- J Gastrointest Surg. 2012 Aug;16(8):1469-77 - PubMed
- Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1525-8 - PubMed
- HPB Surg. 2010;2010:null - PubMed
- Pancreas. 1993 Nov;8(6):659-70 - PubMed
- Surgery. 2011 Jan;149(1):79-86 - PubMed
- Exp Clin Endocrinol Diabetes. 1995;103 Suppl 2:23-26 - PubMed
- Surg Clin North Am. 1978 Apr;58(2):365-82 - PubMed
- N Engl J Med. 1995 Jun 1;332(22):1482-90 - PubMed
- Ann Surg. 2001 Mar;233(3):423-31 - PubMed
- Transplantation. 2011 Apr 27;91(8):895-901 - PubMed
- J Gastrointest Surg. 2003 Dec;7(8):978-89 - PubMed
- J Am Coll Surg. 2014 Apr;218(4):530-43 - PubMed
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