OBJECTIVE Total pancreatectomy with islet autotransplantation (TPIAT) is indicated to alleviate debilitating pancreas-related pain and mitigate diabetes in patients with acute recurrent and chronic pancreatitis when medical/endoscopic therapies fail. Our aim was to evaluate predictors of insulin requirement at 1 year following TPIAT in a cohort of children. RESEARCH DESIGN AND METHODS This was a review of 43 pediatric patients followed after TPIAT for 1 year or longer. Primary outcome was insulin use at 1 year, categorized as follows: insulin independent, low insulin requirement (<0.5 units/kg/day), or high insulin requirement (≥0.5 units/kg/day). RESULTS At 1 year after TPIAT, 12 of 41 (29%) patients were insulin independent and 21 of 41 (51%) had low and 8 of 41 (20%) had high insulin requirement. Insulin-independent patients were younger than those with low and high insulin requirement (median age 8.2 vs. 14.6 vs. 13.1 years, respectively; P = 0.03). Patients with insulin independence had a higher number of transplanted islet equivalents (IEQ) per kilogram body weight (P = 0.03) and smaller body surface area (P = 0.02), compared with those with insulin dependence. Preoperative exocrine insufficiency was associated with high insulin requirement (P = 0.03). Higher peak C-peptide measured by stimulated mixed-meal tolerance testing (MMTT) at 3 and 6 months post-TPIAT was predictive of lower insulin requirement at 1 year (P = 0.006 and 0.03, respectively). CONCLUSIONS We conclude that insulin independence following pediatric TPIAT is multifactorial and associated with younger age, higher IEQ per kilogram body weight transplanted, and smaller body surface area at time of operation. Higher peak C-peptide measured by MMTT following TPIAT confers a higher likelihood of low insulin requirement.

中文翻译：

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胰岛自体移植小儿全胰腺切除术后 1 年血糖结果的预测因素

目的 胰岛自体移植全胰腺切除术 (TPIAT) 适用于在药物/内窥镜治疗失败时缓解急性复发性和慢性胰腺炎患者的衰弱性胰腺相关疼痛和糖尿病。我们的目的是在一组儿童中评估 TPIAT 后 1 年胰岛素需求的预测因素。研究设计和方法 这是对 43 名在 TPIAT 后随访 1 年或更长时间的儿科患者的回顾。主要结果是 1 年时的胰岛素使用情况，分类如下：胰岛素独立、低胰岛素需求（<0.5 单位/kg/天）或高胰岛素需求（≥0.5 单位/kg/天）。结果 TPIAT 后 1 年，41 名患者中有 12 名 (29%) 不依赖胰岛素​​，41 名患者中有 21 名 (51%) 胰岛素需求低，41 名患者中有 8 名 (20%) 胰岛素需求高。不依赖胰岛素​​的患者比胰岛素需求低和高的患者年轻（中位年龄分别为 8.2 岁和 14.6 岁和 13.1 岁；P = 0.03）。与胰岛素依赖患者相比，胰岛素依赖患者每千克体重的移植胰岛当量 (IEQ) 数量较多 (P = 0.03)，体表面积较小 (P = 0.02)。术前外分泌功能不全与高胰岛素需求相关（P = 0.03）。在 TPIAT 后 3 个月和 6 个月通过刺激混合膳食耐受试验 (MMTT) 测量的较高峰值 C 肽可预测 1 年时的较低胰岛素需求（分别为 P = 0.006 和 0.03）。结 和较小的体表面积在操作时。TPIAT 后通过 MMTT 测量的更高峰值 C 肽表明胰岛素需求较低的可能性更高。