Glycemic Outcomes at One Year Post Pediatric TPIAT

Total pancreatectomy with islet autotransplantation (TPIAT) is indicated to alleviate pain and mitigate diabetes in patients with chronic pancreatitis when medical/endoscopic therapies have failed. Predictors of insulin independence and graft function have not been well studied in pediatric TPIAT patients. Our aim was to evaluate predictors of insulin requirement at one year post-TPIAT. This was a retrospective review of 35 patients (<20 years old) who were followed for at least one year post-TPIAT. Primary outcome was insulin use at one year, categorized as either: insulin independent, low insulin (< 0.5 u/kg/day) requirement, or high insulin (≥ 0.5 u/kg/day) requirement. Clinical and pre- and postoperative metabolic data were collected including c-peptide, glucose and insulin levels from mixed meal studies and transplanted islet equivalents per body weight (IEQ/kg). At one year post-TPIAT, 9/35 (26%) patients were insulin independent, 18/35 (51%) had low insulin requirement and 8/35 (23%) had high insulin requirement. Insulin independent patients were younger than those with low and high insulin requirement (median age 9.6 vs. 14.6 vs. 13.1 years, respectively; p=0.05). Patient groups were similar in gender, IEQ/kg transplanted, BMI, disease duration and genetic risks. Preoperative exocrine insufficiency was associated with higher insulin requirement (p=0.04). Pre-TPIAT metabolic markers were not associated with one year insulin outcomes. Higher fasting glucose at 9 months post-TPIAT was significantly associated with increased odds of higher insulin requirement at one year (p=0.007). Higher peak c-peptide at 3, 6 and 9 months post-TPIAT was associated with decreased odds of being on higher insulin requirements after controlling for baseline BMI percentile. Insulin independence at one year post-TPIAT was associated with younger age and exocrine sufficiency at time of operation. Higher peak c-peptide at 3, 6 and 9 months post-TPIAT were associated with lower insulin requirements at one year following operation. Disclosure S. Swauger: None. L. Hornung: None. D.A. Elder: None. J.D. Nathan: None. M. Abu-El-Haija: None.