Abstract：
OBJECTIVE: Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment for patients with chronic pancreatitis (CP) when other interventions are unsuccessful. CP has many etiologies including heredity. Metabolic and pain relief outcomes after TPIAT are presented among patients with a genetic CP etiology compared with those with a nongenetic etiology in a large cohort of patients who underwent this procedure at our center.
METHODS: A retrospective analysis was performed of 237 patients undergoing TPIAT between 2006 and 2023. We analyzed the differences in patients with genetic (n = 56) vs nongenetic CP etiologies (n = 181) in terms of pre-TPIAT factors including patient characteristics and disease state, results from the isolation process, and outcomes such as long-term glycemic and pain control.
RESULTS: Patients with genetic CP underwent TPIAT at a significantly younger age (32.3 vs 41.3 years nongenetic; P < .0001) and endured symptoms for a significantly longer period (10 vs 6 years; P < .01). A significantly lower mass of islets was isolated from patients with genetic CP (P < .01), which increased with body mass index in both groups. Despite lower yields, patients with genetic CP maintained metabolic function similar to patients with nongenetic CP, as indicated by insulin independence and C-peptide, blood glucose, and hemoglobin A1C levels after TPIAT. Post-transplant narcotic usage and pain scores significantly decreased compared with those before TPIAT, and more patients with genetic CP were pain free and narcotic free after TPIAT.
CONCLUSIONS: Our data validate TPIAT as a beneficial procedure for patients enduring CP of genetic etiology. Pain that is inevitably recurrent after minor interventions owing to the nature of the disease and favorable TPIAT outcomes should be considered in the decision to perform early TPIAT in cases of genetic CP.
METHODS: A retrospective analysis was performed of 237 patients undergoing TPIAT between 2006 and 2023. We analyzed the differences in patients with genetic (n = 56) vs nongenetic CP etiologies (n = 181) in terms of pre-TPIAT factors including patient characteristics and disease state, results from the isolation process, and outcomes such as long-term glycemic and pain control.
RESULTS: Patients with genetic CP underwent TPIAT at a significantly younger age (32.3 vs 41.3 years nongenetic; P < .0001) and endured symptoms for a significantly longer period (10 vs 6 years; P < .01). A significantly lower mass of islets was isolated from patients with genetic CP (P < .01), which increased with body mass index in both groups. Despite lower yields, patients with genetic CP maintained metabolic function similar to patients with nongenetic CP, as indicated by insulin independence and C-peptide, blood glucose, and hemoglobin A1C levels after TPIAT. Post-transplant narcotic usage and pain scores significantly decreased compared with those before TPIAT, and more patients with genetic CP were pain free and narcotic free after TPIAT.
CONCLUSIONS: Our data validate TPIAT as a beneficial procedure for patients enduring CP of genetic etiology. Pain that is inevitably recurrent after minor interventions owing to the nature of the disease and favorable TPIAT outcomes should be considered in the decision to perform early TPIAT in cases of genetic CP.
摘要：
目的：对于其他干预措施不成功的慢性胰腺炎（CP）患者，胰岛自体移植全胰腺切除术（TPIAT）是一种有效的治疗方法。CP有多种病因，包括遗传。在我们中心接受此手术的大量患者中，与具有非遗传病因的患者相比，具有遗传CP病因的患者在TPIAT后的代谢和疼痛缓解结果。
方法：对2006年至2023年的237例TPIAT患者进行了回顾性分析。我们分析了遗传（n=56）与非遗传（n=181）CP病因患者在TPIAT前因素（包括患者特征和疾病状态）方面的差异，隔离过程的结果，以及长期血糖和疼痛控制等结果。
结果：患有遗传性CP的患者在明显年轻时接受了TPIAT（32.3岁vs41.3岁的非遗传性，p<0.0001)，并且忍受症状的时间明显更长(10年vs6年，p<0.01)。从患有遗传性CP的患者中分离出明显较低的胰岛质量（p<0.01），两组的体重指数均增加。尽管收益率较低，遗传性CP患者保持代谢功能，如非遗传性CP患者，如胰岛素独立性和C肽所示，血糖，和TPIAT后的血红蛋白A1c水平。与TPIAT前相比，移植后麻醉药的使用和疼痛评分显着降低，更多的遗传性CP患者在TPIAT后无痛无麻醉。
结论：我们的数据证实TPIAT对于患有遗传病因的CP患者是一种有益的治疗方法。由于疾病的性质和有利的TPIAT结果，在决定在遗传性CP的情况下进行早期TPIAT时，应考虑在轻微干预后不可避免地复发的疼痛。
方法：对2006年至2023年的237例TPIAT患者进行了回顾性分析。我们分析了遗传（n=56）与非遗传（n=181）CP病因患者在TPIAT前因素（包括患者特征和疾病状态）方面的差异，隔离过程的结果，以及长期血糖和疼痛控制等结果。
结果：患有遗传性CP的患者在明显年轻时接受了TPIAT（32.3岁vs41.3岁的非遗传性，p<0.0001)，并且忍受症状的时间明显更长(10年vs6年，p<0.01)。从患有遗传性CP的患者中分离出明显较低的胰岛质量（p<0.01），两组的体重指数均增加。尽管收益率较低，遗传性CP患者保持代谢功能，如非遗传性CP患者，如胰岛素独立性和C肽所示，血糖，和TPIAT后的血红蛋白A1c水平。与TPIAT前相比，移植后麻醉药的使用和疼痛评分显着降低，更多的遗传性CP患者在TPIAT后无痛无麻醉。
结论：我们的数据证实TPIAT对于患有遗传病因的CP患者是一种有益的治疗方法。由于疾病的性质和有利的TPIAT结果，在决定在遗传性CP的情况下进行早期TPIAT时，应考虑在轻微干预后不可避免地复发的疼痛。
