Back to 2011 Program

Background: The primary goal in TP-IAT is to improve QOL by alleviating pain and discontinue narcotics while preventing or minimizing surgical diabetes. QOL outcomes following any surgery for CP are lacking. Objective: Review the results of TP-AIT by assessing QOL and beta cell function. Methods: A retrospective review of a prospective database for TP-IAT from November 2007 through October 2010. A standardized pre and post-operative using the Depression Anxiety Stress Scale (DASS) and the Pain Disability Index (PDI). A visual analogue pain scale was used to asses global pain. Diabetes assessment by measuring Hb 1Ac pre and post surgery, and C-Peptide postoperative. Results: There were 20 patients who underwent TP-AITD. The median age was 42 years old (17-73) and 8 (40%) were women. CP etiology was: idiopathic in 10(50%), familiar in 5, alcohol in 4, autoimmune and gallstones in 1 each. Prior pancreatic resection was performed in 2(10%) patients. The median islet cell equivalents infused was 299,508. There was no mortality. Complications were present in 8(40%): bleeding in 4(20%) due to anticoagulation 2 of theses required a reoperation; gastroparesia in 3(15%). Median LOS was 12 days. The median follow-up was 16 months. The mean pre HbA1c was 6.03 and post Hb A1c was 7.72. The median post-op C-peptide levels were 0.78. Dose of Novolog were 12U (4-25) per day, Lantus 9.71U (5-20) per day, Humolog 7.5U (2-30).The QOL data are summarize in the table 1.The patients graded their abdominal pain pre and postoperative are as follows: none to mild in [0(0%)vs15(76%)], moderate in [9(45%)vs3(14%)] and severe in [11(55%)vs2(10%)].The DASS was completed pre and post operative: Depression was categorized as follows: mild in [3(14%)vs2(10%)], moderate in [3(14%)vs1(4%)], severe [4(19%)vs0], extremely-severe [3(14%)vs2(10%)] (p=0.012). Anxiety was categorized as mild in [2(10%)vs1(4%)], moderate in [4(19%)vs1(4%)], severe in [1(4%)vs1(4%)], extremely-severe [4(19%)vs2(10%)] (p=0.062). PDI was completed both pre and post operative: 1. Family/home responsibilities: Severe in [12(61%)vs2(10%)]. 2. Recreation: Severe in [16(80%)vs4(20%)]. 3. Social Activity: Severe in [13(66%)vs3(15%)]. 4.Ocupation: Severe in[14(70%)vs3(20%)]. 5.Sexual Behavior: Severe in [11(55%)vs2(10%)]. 6.Self care: Severe in [6(30%)vs0(0%)] patients. 7.Life support activities: Severe in [9(45%)vs1(10%)]. Alcohol and drug abuse was diagnosed in 3 patients post-operative. Passive suicidal ideation was present in 2 patients.Conclusions: These preliminary results show that TP-AIT significantly improves pain, depression, anxiety and QOL measures in appropriately selected patients with CP.

Table 1	PreOp	PostOp	p Value
PDI
Family Home responsabilities
Severe	12(61%)	2(10%)
Recreation
Severe	16(80%)	4 (20%)
Social Activity
Severe	13 (66%)	3 (15%)
Ocupation
Severe	14 (70%)	3 (20%)
Sexual Behavior
Severe	11 (55%)	2 (10%)
Self care
Severe	6 (30%)	0%
Life support activity
Severe	9 (45%)	1 (10%)
DASS
Depression			p=0.012
Severe	4 (19%)	0%
Anxiety			p=0.062
Severe	1 (4%)	1 (4%)
Pain Scale
Severe	11 (55%)	2 (10%)