Takita Morihito, Lara Luis F, Naziruddin Bashoo, Shahbazov Rauf, Lawrence Michael C, Kim Peter T, Onaca Nicholas, Burdick James S, Levy Marlon F
Islet Cell Laboratory, Islet Cell Laboratory, Baylor Research Institute, 3410 Worth St. #950, Dallas, TX, 75246, USA,
J Gastrointest Surg. 2015 Jul;19(7):1236-46. doi: 10.1007/s11605-015-2828-x. Epub 2015 May 2.
Total pancreatectomy (TP) with islet autotransplantation (IAT) is a highly selected treatment for severe pain associated with chronic pancreatitis (CP) after exhausting medical and endoscopic therapies. The effect of duration of CP on TP-IAT has not been clarified.
Retrospective review of a consecutive cohort undergoing TP-IAT was performed. Patients were classified according to islet dose of <2500 IEQ/kg, 2500 to 5000 IEQ/kg, and >5000 IEQ/kg. Islet yield and metabolic outcomes were compared to disease duration of CP.
A total of 76 CP patients underwent TP-IAT. Longer disease duration was associated with lower islet yield transplanted (Spearman's correlation = -0.24; p = 0.04) for total cohort. Highest absolute value of the coefficient was found in patients with hereditary CP when study subjects were classified by the etiology of CP (correlation = -0.72; p = 0.02). Higher islet yields were significantly associated with better metabolic outcomes (7.6 ± 1.1 vs 6.6 ± 1.1% of HbA1c post-TPIAT in patients with <2500 and >5000 IEQ/kg transplanted, respectively; p = 0.04).
The duration of CP could affect islet yield and metabolic outcomes. The time since the diagnosis of CP should be considered when selecting patients for islet autotransplantation.
全胰切除术（TP）联合胰岛自体移植（IAT）是在药物和内镜治疗均无效后，针对慢性胰腺炎（CP）相关严重疼痛的一种高度选择性治疗方法。CP病程对TP-IAT的影响尚未明确。
对接受TP-IAT的连续队列进行回顾性研究。根据胰岛剂量将患者分为<2500 IEQ/kg、2500至5000 IEQ/kg和>5000 IEQ/kg三组。将胰岛产量和代谢结果与CP的病程进行比较。
共有76例CP患者接受了TP-IAT。总体队列中，病程较长与移植的胰岛产量较低相关（斯皮尔曼相关性=-0.24；p=0.04）。当根据CP病因对研究对象进行分类时，遗传性CP患者的系数绝对值最高（相关性=-0.72；p=0.02）。较高的胰岛产量与更好的代谢结果显著相关（移植胰岛剂量<2500和>5000 IEQ/kg的患者在TP-IAT后HbA1c分别为7.6±1.1%和6.6±1.1%；p=0.04）。
CP病程可能影响胰岛产量和代谢结果。在选择进行胰岛自体移植的患者时，应考虑自CP诊断以来的时间。
