Intraportal Islet Autotransplantation Independently Improves Quality of Life after Total Pancreatectomy in Patients with Chronic Refractory Pancreatitis.

OBJECTIVE: To determine if islet autotransplantation (IAT) independently improves quality of life in patients after total pancreatectomy and islet auto transplantation (TP-IAT).

SUMMARY BACKGROUND DATA: TP-IAT is increasingly being used for intractable chronic pancreatitis. However, the impact of IAT on long-term islet function and QoL is unclear.

METHODS: TP-IAT patients at our center >1 year after TP-IAT with ≥1 Short Form-36 QoL measure were included. Patients were classified as insulin independent or dependent, and as having islet graft function or failure by C-peptide. The associations of insulin use and islet graft function with QoL measures were analyzed by using a linear mixed model, accounting for time since transplant and within-person correlation.

RESULTS: Among 817 islet autograft recipients, 564 patients (median [IQR) age 34 [20,45] years, 71% female) and 2161 total QoL surveys were included. QoL data were available for >5 years after TP-IAT for 42.7% and for >10 years for 17.3%. Insulin-independent patients exhibited higher QoL in 7 of 8 subscale domains and for physical component summary (PCS) and mental component summary scores (P<0.05 for all). PCS was 2.91 (SE 0.57) higher in insulin-independent patients (P<0.001). No differences in QoL were observed between those with and without graft function, but islet graft failure was rare (15% of patients). However, hemoglobin A1c was much higher with islet graft failure.

CONCLUSIONS: QoL is significantly improved when insulin independence is present, and HbA1c is lower with a functioning islet graft. These data support offering IAT, rather than just performing TP and treating with exogenous insulin.