A total pancreatectomy with islet autotransplantation (TPIAT) is an eight- to 10-hour surgery that takes place in two stages:

• Stage 1 is a total pancreatectomy, which involves surgically removing the pancreas and reconstructing the gastrointestinal tract to relieve the severe abdominal pain patients may experience. However, this does cause a problem: without a pancreas, the patient will develop insulin-dependent diabetes, a serious lifelong disease.
• This is where stage 2, called islet autotransplantation, comes in. Islet cells live in the pancreas and produce insulin and other hormones that regulate blood sugar levels. After the pancreas is removed, lab technicians isolate the islets from the diseased organ. This process takes about four hours, after which the surgeon injects the islets into the patient’s liver.

The goal is for the transplanted islets to begin producing insulin in the liver, which can lessen or even eliminate the patient’s risk of developing diabetes. However, it can take several months or longer to know whether the islets will function properly.

In the meantime, the child is treated with insulin therapy. This involves frequent doses of “exogenous” insulin—insulin that is manufactured by a pharmaceutical company, rather than produced by islets. Exogenous insulin is delivered by injections or by a pump.

Patients with severe, debilitating pain caused by chronic or acute recurrent pancreatitis may benefit from TPIAT. Your child’s doctor may recommend it if other treatments have failed.

Patients who undergo TPIAT typically have been experiencing this type of abdominal pain for more than six months. They are unable to go to school or be active, and have been hospitalized one or more times for the pain.

The weeks and months following surgery are very important for your child’s long-term success. We ask that your child remain in Greater Cincinnati for about four to six weeks after leaving the hospital. Our guest services team is available to assist you in planning for the temporary relocation needed for the procedure.

During those first four to six weeks, you and your child will return to the Pancreas Care Center for frequent follow-up appointments with our multidisciplinary care team. Our team will:

• Monitor your child’s blood glucose control and islet function.
• Adjust medications as necessary.
• Make sure your child is getting the nutrition he or she needs before and after the feeding tube is removed.
• Wean your child from pain medications.

After this initial follow-up period, your child will return to the clinic less frequently for check ups.

Most patients report significant pain relief and an improvement in their quality of life following TPIAT. In the months following surgery, they typically can return to school, social activities and even sports. Many patients are able to dramatically reduce or eliminate their need for narcotic pain relief.

Knowing whether your child will remain on insulin therapy takes longer—up to a few months to a year or more.

From now on, your child will have to take medication to replace certain digestive enzymes that are normally produced in the pancreas (pancreatic enzyme replacement therapy). However, your child will not need to take anti-rejection drugs after TPIAT, since the islets are transplanted from his or her own body and not from a donor.