Fat Soluble Vitamin Deficiency Is Common In Children With Chronic Pancreatitis Undergoing Total Pancreatectomy With Islet Autotransplantation
*Kendall R McEachron, Daniel Saltzman, *Elissa M. Downs, *Sarah J. Schwarzenberg, *Srinath Chinnakotla, *Melena D. Bellin
University of Minnesota, Minneapolis, MN
Objectives: Exocrine pancreatic insufficiency (EPI) is a risk factor for malabsorption of fat-soluble vitamins (FSV), but the prevalence of FSV deficiency in children with chronic pancreatitis (CP) is unknown. We sought to quantify the prevalence of and factors associated with FSV deficiencies in children with CP undergoing total pancreatectomy with islet autotransplantation (TPIAT), before and after surgery. Methods: Retrospective review of data collected on pediatric (age<18) TPIAT patients from 2010-2019. FSV levels (vitamins A, E, D) routinely collected pre- and one year post-TPIAT were abstracted. Vitamins A and E were classified as sufficient or low, and vitamin D was classified as sufficient, insufficient, or deficient. Chi-square, linear regression, and logistic regression were used for analysis, with p<0.05 considered significant. Results: One-hundred patients, mean age 12 years, were identified. Sixty patients were female, and 81 had hereditary CP. Longer duration of CP pain was associated with increased risk of low (insufficient or deficient) pre-TPIAT vitamin D levels after adjustment for BMI, presence of EPI, prior pancreas surgery, disease etiology, and season of vitamin D measurement (adjusted p=0.01). Seven years of pain was the threshold for insufficient vitamin D on linear regression. Prevalence of FSV deficiencies pre- versus post-TPIAT are shown in Table 1. There was a higher proportion of patients with vitamin A deficiency post-TPIAT (p<0.0001). There were no significant differences in other FSV deficiencies from pre- to post-TPIAT. On multivariate analysis low FSV levels post-TPIAT, including vitamin A, were not significantly associated with pancreatic enzyme dose, BMI percentile, or etiology of disease.Conclusions: Fat-soluble vitamin deficiencies are common among children undergoing total pancreatectomy with islet autotransplantation, and patients who have had a longer duration of pancreatitis pain may need particular attention to vitamin D supplementation. TPIAT may disproportionately affect vitamin A levels regardless of pancreatic enzyme dosing, and all patients who have undergone TPIAT should be routinely maintained on fat-soluble vitamin supplements titrated to closely monitored serum levels.
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