Clinician-to-Clinician Update Clinician-to-Clinician Update

TP-IAT Relieves Lifelong Pain

January 2015 - Transplant Services

TP-IAT is indicated for children with chronic pancreatitis and abdominal pain of at least 6 months duration with impaired quality of life, such as inability to attend school, inability to participate in ordinary activities, repeated hospitalizations, or constant need for narcotics, coupled with failure to respond to maximal medical treatment or endoscopic pancreatic duct drainage procedures. In this case study, we illustrate the dramatic improvements in pain and quality of life these patients may experience after TP-IAT.

Patient

A 5-year-old boy presented to his local medical center in January 2014 with a 6-month history of abdominal pain, loss of appetite, episodic vomiting, and difficulty sleeping through the night. An ultrasound found an enlarged pancreas, and blood tests revealed elevated pancreatic enzymes. The child was diagnosed with chronic pancreatitis and referred to a tertiary hospital. There, endoscopy revealed constrictions in the pancreatic duct, and a stent was placed. Between April and July 2014, replacement stents were placed four more times due to clogging or displacement. In July 2014, in severe pain, the child was airlifted to University of Minnesota Masonic Children’s Hospital.

Treatment

A TP-IAT was recommended, to which the parents agreed. The procedure was successful, although the boy was re-hospitalized 14 days postdischarge due to small bowel intussusception. This resolved without sequelae. The patient currently receives insulin routinely, although recent bloodwork suggests that the transplanted islet cells are beginning to produce insulin. He no longer suffers with daily pain, has resumed eating normally, and is able to sleep through the night. The family is extremely happy with the patient’s progress.

Discussion

A recent review of 75 children who underwent TP-IAT at University of Minnesota Masonic Children’s hospital between 1989 and 2012 found that over 95% had significant pain relief and improved quality of life.1 About 40% of children achieved insulin independence, some for 10 years and counting. Importantly, even the children who had only partial islet function and who required some insulin on a daily basis had a significantly improved quality of life compared with their pre-TP-IAT status.

References

1. Chinnakotla S, et al. Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes. Ann Surg. 2014; 260:56-64.

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