Sixth International Symposium on Inherited Diseases of the Pancreas Recurrent Acute & Chronic Pancreatitis: Defining Disease & Targeting Treatment Advancing the War on Pancreatic Cancer CAPER Annual Meeting & Young Investigators’ Session

s as of 7.28.10 #1 Quality of Life After Total Pancreatectomy and Islet Autotransplant for Management of Chronic Pancreatitis in Children Melena D. Bellin, Martin L. Freeman, Sarah J. Schwarzenberg, David M. Radosevich, Ty B. Dunn, Gregory J. Beilman, David E.R. Sutherland Corresponding Author: Melena Bellin, MD, [email protected]; phone 612-625-4686; fax 612-626-5262 Background: Children with painful chronic pancreatitis (CP) that is refractory to medical and endoscopic therapies are candidates for total pancreatectomy and islet autotransplant (TP/IAT). Initial retrospective studies in pediatric patients undergoing this procedure suggest that the majority experience significant pain relief, and half are insulin independent at 1 year. Objective measures of quality of life are lacking. Objectives: The primary aim was to determine if quality of life is improved in pediatric patients undergoing TP/IAT, using a standardized measure for health-related quality of life (SF-36). Methods: Nineteen consecutive children with CP scheduled for TP/IAT from December 2006 to December 2009 at the University of Minnesota were enrolled in this prospective analysis. Health questionnaires including the Medical Outcomes Study 36-item short form (SF-36) were administered at baseline and 3 months, 6 months, and annually after surgery. Hemoglobin A1c, glucose, and C-peptide levels were measured. Insulin use was recorded. Results: Patients were 14.5 ± 3.6 years (range 5-18 years) at the time of surgery. One patient had pre-existing C-peptide positive diabetes. Six patients had a prior Puestow procedure with or without distal pancreatectomy. Average islet yield was 3,513 ± 2,480 islet equivalents per kilogram body weight (IE/kg) but was substantially lower in those patients with a prior history of Puestow procedure (1,218 ± 1,189 IE/kg compared to 4,457 ± 2,145 IE/kg , p=0.01). Prior to surgery, average health-related quality of life scores on the SF-36 were nearly 2 standard deviations below the population normal. At baseline, mean Physical Component Score (PCS) was 30.2 and a mean Mental Component Score (MCS) was 34.1 (standardized normal =50, standard deviation =10). Both PCS and MCS significantly improved significantly after surgery (figure 1). By 1 year, mean PCS was 50 and mean MCS was 45.7. Seven patients achieved and maintained insulin independence and another 4 have minimal insulin requirements (basal insulin or correction scale only, <0.25 u/kg/day), all with HbA1c levels <6.5%. A prior Puestow was associated with a higher likelihood of insulin dependence (p=0.04)—5 of 6 patients with a prior Puestow required full insulin supplementation (basal-bolus regimen, >0.25 u/kg/d). Conclusions: This study provides the first objective evidence that quality of life is improved after TP/IAT in selected pediatric patients with severe chronic pancreatitis. Notably, both physical and emotional summary component scores on the SF-36, which were nearly 2 standard deviations below the population normal score before surgery, normalized after TP/IAT in these patients. Nearly two-thirds of patients without pre-existing diabetes mellitus require low dose or no insulin therapy. Figure 1: Change in physical component summary scores (triangles, dashed line) and mental component summary scores (squares, solid line) after total pancreatectomy and islet autotransplant. Asterix indicates statistically significant change from baseline (p<0.05).