Objective: 

To determine if islet autotransplantation (IAT) independently improves the quality of life (QoL) in patients after total pancreatectomy and islet autotransplantation (TP-IAT).

Background: 

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 insulin-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 (interquartile range) 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 and Mental Component Summary scores (P<0.05 for all). Physical Component Summary 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, glycosylated hemoglobin was much higher with islet graft failure.

Conclusions: 

QoL is significantly improved when insulin independence is present, and glycosylated hemoglobin is lower with a functioning islet graft. These data support offering IAT, rather than just performing total pancreatectomy and treating with exogenous insulin.

中文翻译：

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门静脉内胰岛自体移植独立改善慢性难治性胰腺炎患者全胰腺切除术后的生活质量

客观的： 

确定胰岛自体移植 (IAT) 是否独立改善全胰腺切除术和胰岛自体移植 (TP-IAT) 后患者的生活质量 (QoL)。

背景： 

TP-IAT 越来越多地用于治疗顽固性慢性胰腺炎。然而，IAT 对长期胰岛功能和生活质量的影响尚不清楚。

方法： 

我们中心的 TP-IAT 患者在 TP-IAT 后 1 年以上且具有 ≥1 个 Short Form-36 QoL 测量值均纳入其中。根据 C 肽，将患者分为胰岛素非依赖性或胰岛素依赖性，以及胰岛移植功能或衰竭。使用线性混合模型分析胰岛素使用和胰岛移植功能与生活质量测量的关联，考虑移植后的时间和人内相关性。

结果： 

在 817 名自体胰岛移植受者中，纳入了 564 名患者[中位（四分位距）年龄：34（20, 45）岁，71% 女性]和 2161 名总体生活质量调查。42.7% 的患者在 TP-IAT 后可获取超过 5 年的生活质量数据，17.3% 的患者可获取超过 10 年的生活质量数据。胰岛素非依赖型患者在 8 个分量表领域中的 7 个领域以及身体成分总结和精神成分总结评分中表现出较高的生活质量（全部P <0.05）。胰岛素非依赖患者的身体成分总结高出 2.91 (SE=0.57) ( P <0.001)。有移植功能和无移植功能的患者之间没有观察到生活质量差异，但胰岛移植失败的情况很少见（15% 的患者）。然而，胰岛移植失败时糖化血红蛋白要高得多。

结论： 

当存在胰岛素独立性时，生活质量显着改善，并且具有功能性胰岛移植物的糖化血红蛋白较低。这些数据支持提供 IAT，而不仅仅是进行全胰腺切除术和外源性胰岛素治疗。