Pre- and Post-Operative Predictors of Insulin Independence from Total Pancreatectomy and Islet Auto-Transplantation

ObjectiveThis study examined the pre- and post-operative variables that are associated with one-year and long-term insulin independence following total pancreatectomy and islet auto-transplantation (TPIAT). Methods: Charts of 46 TPIAT patients seen from 2010 to 2022 in a single hospital system were retrospectively analyzed. Pre- and post-operative variables were compared between short- (one year) and long-term (last follow up outside of year one) insulin-independent versus dependent patients.ResultsNine (20%) and seven (15%) patients achieved short- and long-term insulin independence, respectively. The patients were followed for a median of 2.8 years (IQR 1.0, 4.7). Short term insulin-independence was associated with higher median transplanted islet equivalents IEQ/kg (6,981 vs 4,493, p=0.02), lower units of basal insulin on discharge (7 vs 12, p=0.009), and lower rates of discharge from the hospital with an insulin regimen (67% vs 100%, p=0.006). The odds of having short term insulin independence increased by 80% for every 1,000 increase in IEQ/kg (OR 1.80, CI 1.18 to 3.12, p=0.005) and decreased by 32% for every additional basal unit of insulin on discharge (OR 0.68, CI 0.42 to 0.91, p=0.003) on average. Long-term insulin independence was also associated with transplanted IEQ/kg in univariable analysis. No patient on antihyperglycemic medication prior to surgery achieved insulin independence.ConclusionShort- and long-term insulin independence after TPIAT is associated with higher transplanted IEQ/kg and immediate post-operative variables that can be used to inform the discussions clinicians have with their patients regarding glycemic prognosis following TPIAT. Complete insulin independence remains low following TPIAT.