PRE-OPERATIVE SARCOPENIA PREDICTS LOW ISLET CELL YIELD FOLLOWING TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION (TPIAT) FOR CHRONIC PANCREATITIS (CP)
Guru Trikudanathan*1, Ghislaine Feussom1, Levi Teigen1, Satish Munigala2, Ahmed Dirweesh1, Melena Bellin1
1University of Minnesota, Minneapolis, MN; 2Washington University, St Louis, MO
Background and Aim:
Sarcopenia defined as degenerative loss of skeletal muscle mass associated with aging, represents an objective parameter to measure frailty and to estimate patient's physiologic reserves. It is a robust predictor of post-operative complications in transplantation and major oncologic surgeries. There is no data regarding the prevalence of sarcopenia in chronic pancreatitis or its impact in patients undergoing TPIAT for CP. We sought to estimate the prevalence of sarcopenia, its impact on post-operative morbidity and prediction of islet yield in patients undergoing TPIAT.
Methods:
Adult patients undergoing TPIAT between 2008 to 2018 were identified from our prospectively maintained database and were included if they had CT within 6 months before TPIAT. Skeletal muscle index (SMI) was evaluated by pre-operative CT at the level of L3 vertebra. Sarcopenia was defined as SMI < 52.4 in males and <38.5 in females. Post-operative morbidity occurring within 90 days after TPIAT was graded as per the validated Clavien-Dindo score. The yield of islets was quantified as islet equivalents (IEQ) and IEQ/kg recipient body weight was calculated.
Results:
138 patients [(female-72%), median (range) age-38 (29-47)] who underwent TPIAT for CP were included in the study. 46 (one third) patients were classified as having pre-operative sarcopenia based on CT. Peri-operative blood loss was more common in sarcopenic patients [median (range) 500 (350-1200)]ml as compared to non-sarcopenic [median (range) 250 (200-550)]ml, p=0.002]. Sarcopenia was associated with significantly lower islet yield {median (range) 2315 (1052-3257)} IEQ/kg vs. {3532 (2435-5096)} IEQ/kg, p=0.001. However major post-surgical morbidity (Clavien grade ≥3) was not significantly different between sarcopenic vs non sarcopenic[(10/92) vs.(3/46), p=0.46].
Conclusion:
Pre-operative sarcopenia was associated with low islet yield and increased likelihood for insulin dependence. Body morphometric analysis in pre-operative CT may enable us to identify patients at risk for low islet yield. It is therefore crucial to optimize pre-operative nutrition in CP patients prior to TPIAT.
Back to 2019 Abstracts
