Total pancreatectomy with islet auto-transplantation in pediatric patients results in significantly decreased opioid use, improved long-term pain and quality of life outcomes.

Abstract

Objective: Chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP) cause significant morbidity in pediatric patients and may be candidates for total pancreatectomy with islet auto-transplantation (TPIAT). We examined opioid use and pain outcomes in a large cohort of pediatric patients post-TPIAT at a single institution.

Methods: Prospective data was collected from 105 pediatric patients from 2015 to 2023 with at least 12 months post-operative data available, up to 5 years. Number of patients at each time point dependent on time from surgery, with median time point 36 months post-TPIAT (70.5 % of patients).

Results: Opioid use significantly decreased from 55 % of patients pre-TPIAT (58/105) to 4 % at 12 months post-TPIAT (4/103, p < 0.001), sustained over time with no patients requiring opioids at 60 months (0/23). 60 % of patients with abdominal pain pre-TPIAT (93/105) reported complete resolution of pain at 3 months (48/102, p < 0.001), with downtrend over time, sustained through 60 months (4/25, 16 %). SF-36 physical component summary and SF-10 physical health and psychosocial summaries showed significant improvement over time post-TPIAT (p < 0.0001). Univariable analysis showed no significant association between post-TPIAT opioid use at 12 months and age at TPIAT, gender, duration from first pancreatitis attack to TPIAT, number of endoscopic retrograde cholangiopancreatographies pre-TPIAT, or diagnosis of CP. PRSS1 mutation more likely to have resolution of abdominal pain at 12 months (p = 0.005).

Conclusions: Utilizing a standardized multidisciplinary approach to TPIAT in pediatric patients with pancreatitis showed significant decreases in opioid use and abdominal pain, regardless of severity of disease, pain, or opioid use pre-TPIAT.