A narrative review on the evolution of outcome reporting in total pancreatectomy with islet autotransplantation

Background and Objective: Total pancreatectomy with islet autotransplantation (TPIAT) has evolved as a therapeutic option for patients with chronic pancreatitis (CP) unresponsive to other treatments. This narrative review explores the historical advancements and shifting paradigms in outcome reporting associated with TPIAT, highlighting its impact on patient quality of life and long-term endocrine function. Methods: A narrative review was conducted, adhering to the Narrative Review reporting checklist. PubMed and Google Scholar were used to identify reports published using the following key words: total pancreatectomy, islet autotransplantation, islet transplantation, total pancreatectomy with islet autotransplantation, outcome reporting. Key Content and Findings: The findings underscore the iterative advancements in TPIAT, from early feasibility studies in canine models to cohort studies documenting long-term patient outcomes. Key insights include correlations between islet yield and metabolic success, variability in outcomes across centres, and the transformative impact on pain management and quality of life. Recent collaborative efforts, such as the POST study, demonstrate the growing recognition of TPIAT's clinical value and the shift towards large-scale multi-centre data reporting. Conclusions: TPIAT has undergone substantial evolution over the past three decades, transitioning from experimental procedures to a validated clinical approach for select CP patients. The paradigm shift in outcome reporting, from small case series to large cohort and collaborative studies, has enhanced understanding of patient selection, procedural efficacy, and long-term outcomes. Future directions should focus on refining techniques, broadening collaborative efforts, and addressing variability in patient outcomes to optimise TPIAT's clinical utility.