Imaging Predictors of Pancreatic Health and Islet Yield in Pediatric Total Pancreatectomy with Islet Autotransplantation.

INTRODUCTION

Total pancreatectomy and islet autotransplantation (TPIAT) can alleviate symptoms in chronic pancreatitis. We aimed to identify pre-TPIAT imaging markers predicting explanted pancreas health and islet yield.

METHODS

We retrospectively analyzed 104 pediatric TPIAT patients, excluding those with presurgical diabetes or pancreatic surgeries. Pancreas parenchymal volume was manually segmented, and T1 signal intensity ratio pancreas to spleen (T1 SIRp/s) was calculated. An islet biologist assessed fat infiltration, fibrosis, and islet yield. Logarithmic transformation and regression analyses were used for variance stabilization and predictive modeling.

RESULTS

Ninety-four patients (60% female, median age 12.5 years) were included. Univariate analyses revealed that an increase in pancreas volume was associated with less fibrosis (odds ratio [OR] = 0.88 per 5 mL, 95% CI: 0.77-0.99, P < 0.05), higher pellet volume, total islet equivalent and total islet count. For advanced fibrosis, an increase in T1 SIRp/s was linked to decreased odds (OR = 0.74 per 0.1 unit, 95% CI: 0.59-0.92, P < 0.05), whereas a higher Cambridge score was associated with increased odds (OR = 1.34 per 1 unit of Cambridge, 95% CI: 1.01-1.77, P < 0.05). A model incorporating segmented pancreas volume and T1 SIRp/s predicted advanced fibrosis with an area under receiver operating curve (AUC) of 0.75 (95% CI: 0.64-0.87). In addition, models that included larger pancreas volume and the absence of acute pancreatitis predicted total islet count and total islet equivalent.

DISCUSSION: In children with chronic pancreatitis, noninvasive cross-sectional imaging focused on the parenchyma can guide the management, as a smaller parenchymal bulk and lower T1 SIRp/s predict advanced fibrosis, whereas larger pancreas volume and T1 SIRp/s predict larger pellet volumes.