Total pancreatectomy with islet autotransplantation (TPIAT) offers metabolic benefit for patients with intractable recurrent or chronic pancreatitis. A multicenter cohort study published in Diabetes Care analyzed 384 patients enrolled in the NIH-sponsored Prospective Observational Study of TPIAT (POST) to identify predictors of favorable diabetes outcomes.

At one year, 83% of patients retained islet function (C-peptide >0.3 ng/mL), 20% discontinued insulin, and 60% maintained HbA1c below 7%. Children and patients with normoglycemia before surgery achieved the best results. Multivariable analysis showed that pediatric age (OR 2.3, 95% CI 1.3–4.3) and lower pre-TPIAT HbA1c (OR 4.0, 95% CI 1.7–9.1 per 1% decrease) predicted insulin independence. Lower preoperative HbA1c also improved the likelihood of reaching HbA1c <7% (OR 2.2, 95% CI 1.1–4.3). Higher fasting C-peptide strongly predicted preserved graft function (OR 2.18, 95% CI 1.42–3.35).

The findings highlight that children and patients with strong preoperative glycemic profiles are most likely to achieve durable metabolic control after TPIAT.