When less invasive treatment options are not successful, total pancreatectomy with islet auto transplantation (TPIAT) may be a solution for those with chronic pancreatitis. TPIAT is a complex surgery that removes the pancreas, either partially or completely. The pancreas is broken down and insulin-producing cells call islets are isolated. The damaged part of the pancreas is discarded and the islets are placed into the liver (transplanted). The islets begin to function within the liver, helping to prevent diabetes. The goal of TPIAT is to relieve the symptoms from chronic pancreatitis while avoiding causing severe diabetes.
The process for an islet cell transplant evaluation, includes appointments with:
- The medical director of the islet cell program who decides if an islet cell transplant would be a good treatment option
- The islet cell team if islet cell transplant is a possibility
- The surgical director of the program who decides if you are an appropriate candidate for the surgery
- An endocrinologist who determines your chance of developing diabetes after the surgery
- A psychiatrist
- A pain specialist
- A dietitian
After these evaluations, there is an islet cell multidisciplinary team meeting. The decision to proceed with surgery must be unanimous from all team members. Almost half of the patients who go through the evaluation process are not candidates for this complex surgery. We also discuss other options that may serve your medical needs. If we recommend surgery, the TPIAT Coordinator will contact you to discuss a plan including:
- Clinic visits with team members prior to surgery
- Computed Tomography (CT) scans
- Family Medical Leave Act (FMLA)/disability paperwork assistance
- Insurance application assistance, if needed
- Preadmission testing
- Pre-certification with insurance company
- Working with your employer regarding time away and returning to work
The surgical experience
The day of surgery
On the day of the surgery, after you arrive in the operating room and are under anesthesia, the surgeons will remove the whole or part of the pancreas. This process takes 3 to 4 hours. Once the pancreas is removed, the surgeon isolates the islet cells from the pancreas. This process occurs right in the operating room and takes about four hours. While the islet cells are being isolated, the surgeon is busy reconnecting the intestine back together.
Once the islet cells are ready, the surgeon puts them back into the body via tubing that leads into the vein which allows the islet cells to be transplanted. This process takes about an hour and completes the surgery. The patient is then brought to the recovery area and eventually to their hospital bed. All together, the entire operation takes between 7 to 10 hours.
Most patients are able to leave the hospital 7 to 14 days after the surgery.
After you are home from the hospital, you will continue to follow-up with your surgeon, endocrinologist and gastroenterologist on a regular schedule.
Initially, these appointments will be monthly, but will become less frequent over time. Because there is no pancreas, you will have to take pancreatic enzyme replacement therapy (PERT) daily for the rest of your life. This requires between 3 to 6 pills per day so that you can digest your food adequately. In addition, about 1/3 of patients will require insulin forever for treatment of non-brittle diabetes.