When less invasive treatment options are not successful, total pancreatectomy with islet auto transplantation (TPIAT) may be a solution for those with chronic pancreatitis.
What is TPIAT?
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.
Watch this video to learn about Total Pancreatectomy with Islet Auto Transplantation surgery.
Evaluation
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 pancreas surgeon 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 dietitian to help with your diagnosis-specific nutrition needs
- A psychologist to make sure you are emotionally prepared for the surgical process
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 all 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 portal vein which allows the islet cells to be transplanted into the liver. This process takes about an hour and completes the all-day surgery. The patient is then brought to the recovery area and eventually to their hospital bed. Altogether, 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 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 that you take pancreas enzyme pills with your meals so that you can digest your food adequately. In addition, about one third of patients will require insulin forever for treatment of non-brittle diabetes.