{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:30:43Z","timestamp":1790767843923,"version":"4.1.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T00:00:00Z","timestamp":1691107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Chronic pancreatitis (CP) can result in opioid dependence and nutritional challenges in children. Total pancreatectomy with islet autotransplantation (TPIAT) is a viable surgical option in appropriately selected patients. We examined differences between children who met criteria for TPIAT versus those who did not and continued with non-operative management.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Retrospective observational cohort study of patients evaluated for TPIAT between August 2014 and July 2020 was performed. Cohort-based analyses between TPIAT and non-TPIAT groups were performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Analyses included 121 patients, 69 of whom underwent TPIAT. Demographics, genetic risk factors, and anatomic variants did not differ between groups. TPIAT patients were more likely to have CP (88% vs 71%; <jats:italic>p<\/jats:italic> = 0.02), had higher median number of endoscopic retrograde cholangiopancreatography procedures (2.0 vs 1.0; <jats:italic>p<\/jats:italic> = 0.0001), and had higher likelihood of opioid use (61% vs 42%; <jats:italic>p<\/jats:italic> = 0.04) and nutritional supplementation (23% vs 4%; <jats:italic>p<\/jats:italic> = 0.004), compared to non-TPIAT. At 6 months post-TPIAT, patients had lower use of any analgesic pain medications (39% vs 73%; <jats:italic>p<\/jats:italic> = 0.0002) and lower use of opioids (9% vs 39%; <jats:italic>p<\/jats:italic> = 0.0006), compared to non-TPIAT patients at 6 months after evaluation. At 6 months post-TPIAT, rate of exclusively oral nutrition increased from 77% to 86%, and total parenteral nutrition use decreased from 13% to 0% (<jats:italic>p<\/jats:italic> = 0.02).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In children referred for TPIAT evaluation, there is greater burden of disease in those selected for operation, compared to patients who do not undergo operation. TPIAT achieves lower analgesic pain medication use compared to continuation with non-TPIAT management and achieves freedom from nutritional supplementation.<\/jats:p>\n<jats:p><jats:bold>Level of evidence:<\/jats:bold> Retrospective comparative study, Level III.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0289620","type":"journal-article","created":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T17:29:27Z","timestamp":1691170167000},"page":"e0289620","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Total pancreatectomy with islet autotransplantation reduces opioid use and improves nutritional support in children with debilitating pancreatitis"],"prefix":"10.1371","volume":"18","author":[{"given":"Christie","family":"Heinzman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Hornung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom K.","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen M. O.","family":"Lowe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maisam","family":"Abu-El-Haija","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5867-3326","authenticated-orcid":true,"given":"Jaimie D.","family":"Nathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,8,4]]},"reference":[{"issue":"3","key":"pone.0289620.ref001","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/MPG.0000000000001013","article-title":"Early Enteral Nutrition in Children With Acute Pancreatitis","volume":"62","author":"M Abu-El-Haija","year":"2016","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"5","key":"pone.0289620.ref002","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1067\/mpd.2002.123880","article-title":"The changing incidence of acute pancreatitis in children: a single-institution perspective","volume":"140","author":"MJ Lopez","year":"2002","journal-title":"J Pediatr"},{"issue":"1","key":"pone.0289620.ref003","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/MPA.0b013e3181baac47","article-title":"Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible?","volume":"39","author":"VD Morinville","year":"2010","journal-title":"Pancreas"},{"issue":"2","key":"pone.0289620.ref004","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1053\/j.gastro.2018.04.013","article-title":"Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007\u20132014.","volume":"155","author":"ZM Sellers","year":"2018","journal-title":"Gastroenterology"},{"issue":"5","key":"pone.0289620.ref005","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1053\/j.gastro.2012.08.002","article-title":"Burden of gastrointestinal disease in the United States: 2012 update","volume":"143","author":"AF Peery","year":"2012","journal-title":"Gastroenterology"},{"issue":"9","key":"pone.0289620.ref006","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1097\/MPA.0000000000000918","article-title":"Increased Burden of Pediatric Acute Pancreatitis on the Health Care System","volume":"46","author":"L Hornung","year":"2017","journal-title":"Pancreas"},{"issue":"39","key":"pone.0289620.ref007","doi-asserted-by":"crossref","first-page":"6249","DOI":"10.3748\/wjg.v12.i39.6249","article-title":"Quality of life in chronic pancreatitis","volume":"12","author":"R Pezzilli","year":"2006","journal-title":"World J Gastroenterol"},{"issue":"7","key":"pone.0289620.ref008","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1053\/j.gastro.2018.12.043","article-title":"Pancreatitis in Children.","volume":"156","author":"A Uc","year":"2019","journal-title":"Gastroenterology"},{"issue":"5","key":"pone.0289620.ref009","first-page":"706","article-title":"The Role of Surgical Management in Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology","volume":"74","author":"JD Nathan","year":"2022","journal-title":"Hepatology"},{"issue":"4","key":"pone.0289620.ref010","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1111\/ajt.15150","article-title":"In-hospital and 90-day outcomes after total pancreatectomy with islet autotransplantation for pediatric chronic and acute recurrent pancreatitis.","volume":"19","author":"M Kotagal","year":"2019","journal-title":"Am J Transplant."},{"issue":"1","key":"pone.0289620.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pan.2021.09.011","article-title":"Surgical approach and short-term outcomes in adults and children undergoing total pancreatectomy with islet autotransplantation: A report from the Prospective Observational Study of TPIAT.","volume":"22","author":"JD Nathan","year":"2022","journal-title":"Pancreatology."},{"issue":"4","key":"pone.0289620.ref012","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.pan.2018.04.013","article-title":"Pediatric chronic pancreatitis: Updates in the 21st century.","volume":"18","author":"M Abu-El-Haija","year":"2018","journal-title":"Pancreatology"},{"issue":"4","key":"pone.0289620.ref013","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.pan.2020.04.005","article-title":"The role of total pancreatectomy with islet autotransplantation in the treatment of chronic pancreatitis: A report from the International Consensus Guidelines in chronic pancreatitis.","volume":"20","author":"M Abu-El-Haija","year":"2020","journal-title":"Pancreatology."},{"issue":"1","key":"pone.0289620.ref014","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/S0022-3468(96)90335-8","article-title":"Islet Autotransplantation after total pancreatectomy in a child","volume":"31","author":"DC Wahoff","year":"1996","journal-title":"J Pediatr Surg"},{"issue":"4","key":"pone.0289620.ref015","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.jamcollsurg.2013.12.037","article-title":"Long-term outcomes of total pancreatectomy and islet auto transplantation for hereditary\/genetic pancreatitis","volume":"218","author":"S Chinnakotla","year":"2014","journal-title":"J Am Coll Surg"},{"key":"pone.0289620.ref016","first-page":"94","article-title":"Human Islet Isolation for Clinical Transplantation: University of Minnesota Experience with Different Islet Isolation Protocols and Isolation Enzymes","author":"SM Soltani","year":"2012","journal-title":"Transplantation"},{"issue":"3","key":"pone.0289620.ref017","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/MPG.0b013e31824f1516","article-title":"Definitions of pediatric pancreatitis and survey of present clinical practices","volume":"55","author":"VD Morinville","year":"2012","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"4","key":"pone.0289620.ref018","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1053\/j.sempedsurg.2017.07.004","article-title":"Pediatric pancreas transplantation, including total pancreatectomy with islet autotransplantation.","volume":"26","author":"AJ Bondoc","year":"2017","journal-title":"Semin Pediatr Surg."},{"issue":"3","key":"pone.0289620.ref019","doi-asserted-by":"crossref","first-page":"150925","DOI":"10.1016\/j.sempedsurg.2020.150925","article-title":"Islet cell transplantation in children","volume":"29","author":"AN Balamurugan","year":"2020","journal-title":"Semin Pediatr Surg"},{"issue":"2","key":"pone.0289620.ref020","doi-asserted-by":"crossref","first-page":"295","DOI":"10.2337\/dc21-1222","article-title":"Predictors of Glycemic Outcomes at 1 Year Following Pediatric Total Pancreatectomy With Islet Autotransplantation","volume":"45","author":"SE Swauger","year":"2022","journal-title":"Diabetes Care"},{"issue":"9","key":"pone.0289620.ref021","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.3390\/jcm10091893","article-title":"Continuous Glucose Monitoring in the Intensive Care Unit Following Total Pancreatectomy with Islet Autotransplantation in Children: Establishing Accuracy of the Dexcom G6 Model.","volume":"10","author":"N Segev","year":"2021","journal-title":"J Clin Med."},{"issue":"8","key":"pone.0289620.ref022","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1016\/j.jpedsurg.2019.09.019","article-title":"Extreme thrombocytosis after pediatric pancreatectomy with islet autotransplantation is unique compared to other postsplenectomy states","volume":"55","author":"AA Boucher","year":"2020","journal-title":"Journal of Pediatric Surgery"},{"issue":"5","key":"pone.0289620.ref023","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1097\/MPA.0000000000001313","article-title":"Thrombopoietin Contributes to Extreme Thrombocytosis After Pediatric Pancreatectomy With Islet Autotransplantation","volume":"48","author":"JP Gurria","year":"2019","journal-title":"Pancreas"},{"issue":"8","key":"pone.0289620.ref024","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1016\/j.jpedsurg.2021.10.013","article-title":"Effect of intraoperative fluid type on postoperative systemic inflammatory response and end organ dysfunction following total pancreatectomy with islet autotransplantation in children","volume":"57","author":"GR Goddard","year":"2022","journal-title":"J Pediatr Surg"},{"issue":"4","key":"pone.0289620.ref025","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.amjsurg.2021.01.030","article-title":"Total pancreatectomy with islet autotransplantation reduces resource utilization in pediatric patients.","volume":"222","author":"AF Kassam","year":"2021","journal-title":"Am J Surg"},{"issue":"11","key":"pone.0289620.ref026","doi-asserted-by":"crossref","first-page":"2242","DOI":"10.3390\/jcm10112242","article-title":"Improved Glycemic Outcomes with Early Initiation of Insulin Pump Therapy in Pediatric Postoperative Total Pancreatectomy with Islet Autotransplantation.","volume":"10","author":"SE Tellez","year":"2021","journal-title":"J Clin Med."},{"issue":"1","key":"pone.0289620.ref027","doi-asserted-by":"crossref","first-page":"e13080","DOI":"10.1111\/petr.13080","article-title":"Severe fasting hypoglycemia in a child after total pancreatectomy with islet autotransplantation.","volume":"22","author":"JM Redel","year":"2018","journal-title":"Pediatr Transplant"},{"issue":"4","key":"pone.0289620.ref028","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/j.jpeds.2014.11.019","article-title":"Pediatric chronic pancreatitis is associated with genetic risk factors and substantial disease burden","volume":"166","author":"SJ Schwarzenberg","year":"2015","journal-title":"J Pediatr"},{"issue":"1","key":"pone.0289620.ref029","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/SLA.0000000000000569","article-title":"Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes","volume":"260","author":"S Chinnakotla","year":"2014","journal-title":"Ann Surg"},{"issue":"3","key":"pone.0289620.ref030","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/MPG.0000000000001314","article-title":"Total Pancreatectomy With Islet Autotransplantation Resolves Pain in Young Children With Severe Chronic Pancreatitis","volume":"64","author":"MD Bellin","year":"2017","journal-title":"J Pediatr Gastroenterol Nutr"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0289620","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T17:30:00Z","timestamp":1691170200000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0289620"}},"subtitle":[],"editor":[{"given":"Ashraf","family":"Elbahrawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,8,4]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0289620","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,4]]}}}