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INTRODUCTION: In selected patients with chronic pancreatitis, total pancreatectomy with islet autotransplantation can be effective for the treatment of intractable pain while ameliorating post-operative diabetes. Improved quality of life scores and decreased daily narcotic use, as indicators of successful pain relief, are expected after total pancreatectomy. These outcomes and their relationship have not been previously well examined in this patient group.METHODS: A prospectively collected database of patients undergoing extensive pancreatectomy with islet auto transplantation for pancreatitis was reviewed. Data pertaining to daily oral Morphine Equivalents (MEs) and Quality of Life (QOL), as measured by the SF-12 or SF-36v2 questionnaire, in the preoperative and postoperative period were reviewed. Approval from the IRB for the evaluation of human subjects was obtained. RESULTS: Over a 20 month period, 33 patients (25 women, median age 42) underwent extensive pancreatectomy with islet autotransplantation for pancreatitis. Mean follow-up was 9 months with a range of 6-12 months. Postoperative complications occurred in 20 patients (60%). Preoperative QOL scores were a mean 26 for Physical component and 35 for Mental Health component. Post-operatively, Physical component scores averaged 32 at 6 months and 35 at 12 months (mean increase of 9); the Mental Health component scores averaged 42 at 6 months and 44 at 12 months (mean increase of 7). Pre-operative MEs averaged 357mg daily. At discharge from the hospital, this number increased to 536mg average MEs daily, a 50% increase, as expected after major surgery in the chronic pain patient. At 6 months, 15 out of 31 patients (48%) required less daily MEs than pre-operatively and averaged 161mg daily (-55% ). By 12 months, 11 out of 17 patients (65%) required less daily MEs than pre-operatively and averaged 128mg daily (-64%); 4 were narcotic free (23%). Of the 6 patients who did not decrease their analgesic requirements at one year, 5 (83%) still had an improved Physical QOL score (one patient was unchanged) and all 6 had an improved Mental Health QOL. CONCLUSION: Total pancreatectomy with islet autotransplant is an effective surgery for end stage chronic pancreatitis. Quality of Life improves early post operatively while improved pain control and decreased prescription narcotic analgesia requirements occur later. Both improved Quality of Life and decreased narcotic analgesia requirements continue to occur at least up to 1 year postoperatively. Further investigation is needed to assess the durability of total pancreatectomy with islet auto-transplantation for severe chronic pancreatitis with respect to pain relief and improved quality of life.