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Total Pancreatectomy with Islet Auto Transplantation (TPIAT)

Approximately 500,000 patients have chronic pancreatitis (CP) in the United States; at Dartmouth we follow between 400-500 patients with this condition every year. CP is a lifelong condition of the pancreas that results from a variety of factors. CP often produces chronic and unrelenting pain for patients. Patients suffering from CP also have an increased risk of developing pancreatic cancer compared to the general population.

Treatments for this chronic condition can range from approaches using medications to surgery. The goal of these treatment options is to control pain and improve quality of life. However, they are generally effective for only a limited amount of time depending on the patient. Approximately 50% of CP patients will require some sort of surgical intervention and of those patients 30%-50% will develop recurrent systems or complications related to the disease.

For patients who fail to respond to less aggressive techniques, complete removal of the pancreas is a reasonable option and can provide significant pain relief. One significant side effect of total pancreatectomy is the development of difficult to control diabetes as they are left with no means of producing insulin and other important hormones to regulate their blood sugar. These patients become completely dependent on external sources of insulin, making their blood sugar extremely difficult to regulate, reducing quality of life, and increasing the likelihood of frequent hospital admissions.

Pancreatic islet cells as seen under the microscope

There is a potential solution for those patients who have been unsuccessful with less invasive options to treat CP. The total pancreatectomy with islet auto transplantation (TPIAT) is a complex surgical procedure in which the pancreas is partially or completely removed, the pancreas is broken down and the insulin producing cells (islets) are isolated, the damaged portion of the pancreas discarded. The isolated islet cells are then placed into the patient’s liver.

The islets almost immediately begin to function within the liver, thereby helping to prevent diabetes. The goal of TPIAT is to alleviate the patient’s symptoms from chronic pancreatitis by removing the pancreas while resorting the islet cells to avoid causing severe diabetes.