Purpose: TPIAT is an effective treatment for chronic pancreatitis (CP) and offers improved glycemic control compared to total pancreatectomy alone. However, TPIAT is performed at significantly lower rates in the African American population compared to the Caucasian population, despite the high prevalence of CP in this population. A comparative analysis between these two populations was performed to determine differences in postoperative outcomes following TPIAT.

Methods: 107 Caucasian patients and 15 African American patients were included that had undergone TPIAT and reached the one-year post-op time point. Fisher’s exact test was used to compare demographic and pre-op variables. Wilcoxon rank sums were used to compare 6-month and 1-year post-op variables including HgbA1c, C-peptide, SUITO index, subjective pain scores, and narcotic medication doses.

Results: There were no significant differences in the following demographic and pre-op values: age, sex distribution, BMI, duration of symptoms, etiology, HgbA1c, the prevalence of diabetes, and basal or stimulated SUITO index. Pre-op narcotic doses were higher in the Caucasian group despite similar pre-op pain scores. African American patients were more likely to have a history of pancreatic duct stenting prior to transplantation. Importantly, there were no significant differences in any of the post-op measures at 6 months, including C-peptide, glucose, SUITO, HgbA1c, insulin dose, narcotic dose, or subjective pain score. At 1-year post-op, the only differences in any of these variables were lower insulin dose in the African American cohort.

Conclusion: The lower incidence of TPIAT in African Americans suggests a disparity in the access to care for CP patients. These findings suggest that race should not be considered a contributing factor when assessing whether or not a patient is a candidate for TPIAT. Furthermore, the data suggests that African American patients respond equally or may have better metabolic recovery compared to Caucasians. Finally, a better patient selection process and changes in health policies are needed to promote equity in healthcare access.