ODP232 Postoperative Glycemic Management of Children Undergoing Pancreatectomy with Islet Autotransplantation
Authors: Grimbly Chelsey , Kin Tatsuya , Rosolowsky Elizabeth , Shapiro James , Thorpe Marian 
Published: November 2022

Abstract

Background
Children with severe pancreatitis may require pancreatectomy, resulting in insulin-dependent diabetes. Our center has provided pediatric pancreatectomy with islet autotransplantation (PIAT) since 2003 to preserve pancreatic endocrine function and potentially prevent diabetes. We describe our experience with postoperative glycemic management after pediatric PIAT to provide guidance for future management. Method: We reviewed inpatient records for children who underwent PIAT. Data collected included age, indication for pancreatectomy, islet mass infused and details on insulin and nutritional support requirements. Descriptive analysis was performed.

Results
Twelve pediatric patients have undergone PIAT at our centre, with mean age 12.4 years (range 2.5-18.9) and mean duration of post-operative hospitalization 25 days (range 9-60). Indications for pancreatectomy included ten patients with chronic pancreatitis due to mutations in PRSS1, SPINK1, or CFTR, 1 patient due to trauma, and 1 patient due to tumor. Ten patients underwent total pancreatectomy, and 2 had partial pancreatectomies. Mean islet mass infused per body weight was 5867 IEQ/kg (range 1630-10276). Two patients did not receive insulin during hospitalization. The remaining ten required insulin, with mean maximum total daily dose of 0.9 u/kg/day (range 0.14-1.88). Total daily doses were higher while on parenteral nutrition (mean 0.75 versus 0.27 u/kg/day on days without parenteral nutrition). Duration of insulin therapy was also longer in patients who received parenteral nutrition (mean 25 versus 4 days). Six of the insulin-treated patients were able to discontinue insulin prior to discharge, with mean duration of insulin therapy 13 days (range 1-40). Four remained on insulin at discharge, with a mean total daily dose of 0.46 u/kg/day (range 0.12-0.82). Patients who were on insulin at discharge all had total pancreatectomies, were older (mean 17 versus 9 years), and had smaller islet mass per kilogram infused (mean 2718 versus 8116 IEQ/kg) compared to those not on insulin.

Discussion
We report our center's experience with PIAT. Seven of twelve patients were insulin-independent at discharge, and the remainder needed modest doses. Previous publications on islet autotransplantation have also demonstrated favourable outcomes in children, with insulin independence rates up to 82%1. Younger age and larger islet mass infused per kilogram predicted insulin independence in our cohort, similar to the findings of Chinnakotla et al2. In addition, our study suggests that feeding difficulties requiring parenteral nutrition increase daily insulin requirements and prolong the need for insulin therapy. References: 1. Bondoc, A., Abu-El-Haija, M., & Nathan, J. (2017). Pediatric pancreas transplantation, including total pancreatectomy with islet autotransplantation. Seminars in Pediatric Surgery, 26, 250-256. 2. Chinnakotla, S., Bellin, M., Schwarzenberg, S., Radosevich, D., Cook, M., Dunn, T., . . . Sutherland, D. (2014). Total Pancreatectomy and Islet Auto-Transplantation in Children for Chronic Pancreatitis. Indications, Surgical Techniques, Post Operative Management and Long-Term Outcomes. Ann Surg, 260(1), 56-64.
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