pain medications (54 vs 35%; p=0.002) was higher in patients with Hx of PNT.

(See table Su1447

for additional data). Conclusions: Based on NIH GpCRC registry data, the cumulative
prevalence of PNT was 6.9%. Patients with the Sx of Gp and a Hx of PNT appear to be CLINICAL FEATURES OF IGG4 NEGATIVE AUTOIMMUNE PANCREATITIS
more symptomatic and have greater physiological gastric emptying delay than patients Yoshinori Ohno, Teru Kumagi, Tomoyuki Yokota, Hideki Miyata, Yoshinori Tanaka,
without a Hx of PNT. In addition, there are a number of differences between PNT or non- Keitaro Kawasaki, Fujimasa Tada, Nobuaki Azemoto, Mitsuhito Koizumi, Taira Kuroda,
PNT in nutrition and medication use exist that might help explain this observed phenotypic Yoshiki Imamura, Yoichi Hiasa
variation. Additional work with Gp including detailed assessments of types and classes of
AGA Abstracts

Backgrounds/Objective: Autoimmune pancreatitis (AIP) is a type of chronic pancreas specific

pancreatitis history appears warranted.
inflammation mediated by an autoimmune inflammatory reaction. AIP is associated with
the enlargement of the pancreatic parenchyma and frequent elevations in the serum IgG4
levels. However, about 20% of patients with AIP do not show elevated serum IgG4 levels,
thus its diagnosis is challenging. We aimed to identify the clinical features of AIP patients
without elevated serum IgG4 levels. Methods: Retrospective chart review was conducted at
gastroenterology clinics for 52 newly diagnosed AIP patients excluding type 2 AIP. The
diagnosis of AIP was based on the Japanese diagnostic criteria for AIP 2011 (JPS-2011) or
the International Consensus of Diagnostic Criteria (ICDC). Unclassifiable case is regarded
as AIP not otherwise specified (AIP-NOS) in the ICDC. The serum IgG4 cutoff value was
135 mg/dl. Positive autoantibody included anti-nuclear antibody and/or rheumatoid factor.
The following findings on imaging were evaluated: enlargement of the pancreas and extrapan-
creatic lesions on computed tomography, irregular narrowing of the pancreatic and biliary
stricture by endoscopic retrograde cholangiopancreatography. Results: 42 patients (80.1%)
were male, and the median age was 64 years (32–89 years). Patients presented with jaundice
(N=18, 34.6%), abdominal pain or discomfort (N=17, 32.7%), abnormal abdominal imaging
(N=13, 25%), and worsening of diabetes (N=3, 5.8%). 32 patients (61.5%) had diffuse
pancreatic swelling and 19 patients (36.5%) had obstructive jaundice. Patients had the
following complications: bile duct stricture (N=38, 73.1%) all in intrapancreatic except 4
patients in intrahepatic; retroperitoneal fibrosis (N=7, 13.5%); and sialadenitis (N=2, 3.8%).
31 patients (59.6%) had diabetes: 17 patients preceded the diagnosis of AIP, and 14 patients
were diagnosed simultaneously with the diagnosis of AIP. Among 9 patients (17.3%) with
IgG4 negative AIP, only 2 patients were diagnosed as definitive AIP according to the diagnostic
criteria of AIP: JPS-2011 (definitive: N=1, suspected: N=7, probable: N=1) and the ICDC
(type1 definitive: N=2, AIP-NOS: N=7). All patients with IgG4 negative AIP receiving steroid
showed favorable response and no relapse was seen. When the IgG4 positive AIP (135 mg/
dl≤, N=43) and IgG4 negative AIP (<135 mg/dl, N=9) groups were compared, IgG4 negative
AIP group was significantly younger (median 66 vs. 59, P=0.001), had lower prevalence of
positive autoantibody (57% vs. 11%, P=0.009) and diabetes (67% vs. 22%, P=0.012).
Conclusions: Diagnosis of IgG4 negative AIP is challenging with current diagnostic criteria.
IgG4 negative AIP was younger, had lower autoantibody positivity rate and fewer patients
with diabetes compared to IgG4 positive AIP. IgG4 negative AIP has different clinical features
from IgG4 positive AIP.

Su1448

PREDICTIVE VALUE OF ISLET PROCESSING PARAMETERS ON

Table 1: Patient demographics, BMI, medications, and nutrition by presence of history METABOLIC OUTCOMES AT 6 AND 12 MONTHS FOLLOWING TOTAL
of pancreatitis PANCREATECTOMY AND ISLET AUTOTRANSPLANTATION
Luis F. Lara, Jill Buss, Amer Rajab, Phil A. Hart, Shumei Meng, Black Sylvester, Kristin
Kuntz, Darwin L. Conwell, Ken Washburn
Introduction Pain is the most significant complain of patients with chronic pancreatitis
affecting all other quality of life domains. Total pancreatectomy with islet autotransplantation
(TPIAT) is considered for patients who are refractory to standard therapy. Metabolic outcomes
are not predictable, but selection criteria for an optimal islet dose and subsequent improve-
ment in TPIAT outcomes including pain control and euglycemia are evolving. We evaluated
whether islet cell parameters obtained during the islet isolation process could predict post
TPIAT metabolic outcomes including c-peptide response and insulin independence. Meth-
ods: Data were extracted from a prospective database of subjects (n=14) who have completed
TPIAT at The Ohio State University Wexner Medical Center from 2009-2018. Data was
available in 14 patients. Islet data were assessed, included islet equivalents (IEq), dose (IEq/
kg), quality, percentage of free islets, purity and digestion time. The measured metabolic
outcomes at 6 and 12 months following TPIAT included fasting c-peptide, and daily insulin
dose. Correlation coefficients were calculated to assess the strength of relationships between
the islet isolation data and metabolic outcomes. Results: At last follow-up six (42%) subjects
remained insulin independent. Positive correlations were found with C-peptide level and
islet equivalent at 6 and 12 months, and islet dose at 12 months, respectively (r=0.80-0.88).
See table. A moderate correlation was found between islet dose (r=0.57), islet quality (r=
0.50), and islet purity (r=0.47) with c-peptide levels at 12 months, respectively. Moderate
correlation was noted with insulin dose and islet purity at 6 (r=0.35) and 12 months (r=
0.46), and with digestion time at 6 (r=0.32) and 12 (r=0.47), respectively. Negative correlation
was noted between c-peptide and islet quality and islet purity at 6 months, percentage of
free islets, and islet digestion time at 6 and 12 months. Insulin dose was negatively correlated
with islet equivalent, islet dose, islet quality, and percentage of free islets at 6 and 12 months.
See table. Conclusions These data demonstrate that both islet equivalent and islet dose are
correlated to c-peptide levels following TPIAT. Other parameters including islet quality,
purity, and digestion time were only moderately correlated with metabolic outcomes and
are less helpful for predicting them. Further studies are needed to identify novel predictors
of long-term metabolic outcomes following TPIAT to help identify patients most likely to
benefit from the procedure.
Correlation coefficient (r) between islet isolation parameters and metabolic outcomes

Table 2: Patient gastric symptoms, QOL, and GET by presence of history of pancreatitis

AGA Abstracts S-554