Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 24, 2016; 6(1): 233-238
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.233
Total pancreatectomy and islet autotransplantation: A decade nationwide analysis
Reza Fazlalizadeh, Zhobin Moghadamyeghaneh, Aram N Demirjian, David K Imagawa, Clarence E Foster, Jonathan R Lakey, Michael J Stamos, Hirohito Ichii
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
Jonathan R Lakey, Department of Biomedical Engineering, University of California, Irvine, CA 92697, United States
Author contributions: Fazlalizadeh R and Ichii H designed the research; Fazlalizadeh R and Moghadamyeghaneh Z performed the research and analyzed the data; Fazlalizadeh R wrote the paper; Demirjian AN, Imagawa DK, Foster CE, Lakey JR, Stamos MJ and Ichii H critically revised the manuscript for important intellectual content.
Institutional review board statement: The nationwide inpatient sample (NIS) database has been used for this study, which is appropriate for exemption from IRB since no personal identifiers were used in the registry data.
Informed consent statement: The NIS database is exempt from requiring informed consent from individual patients and is covered within the individual hospital’s patient consent forms.
Conflict-of-interest statement: All the authors have no financial relationship to disclose.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hirohito Ichii, MD, PhD, Associate Professor of Clinical Surgery, Division of Transplant, Department of Surgery, University of California, Irvine, School of Medicine, 333 City Boulevard West Suite 1205, Orange, CA 92868, United States. hichii@uci.edu
Telephone: +1-714-4568698 Fax: +1-714-4568796
Received: July 28, 2015
Peer-review started: August 21, 2015
First decision: October 30, 2015
Revised: January 20, 2016
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: March 24, 2016
Processing time: 212 Days and 5.8 Hours
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 25th 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: Total pancreatectomy; Pancreatectomy; Islet auto transplantation; Chronic pancreatitis; Insulin independency

Core tip: Total pancreatectomy (TP) is the last resort to control the severe pain in patients with chronic pancreatitis due to the morbidity of the operation and the frequent severe resultant diabetes. Islet auto-transplantation (IAT) following TP is reported, by well experienced groups, to be an effective therapy to prevent post-surgical diabetes. However, there is limited nationwide data analysis during the last few decades. The objective of this study was to investigate outcomes and predictors of in-hospital morbidity and mortality after TP + IAT.