Total Pancreatectomy with Islet Auto-Transplantation, or TPIAT, is a complex surgical procedure performed on a very limited subset of patients suffering from pancreatitis. TPIAT is not for all pancreatitis patients. If you are interested in a TPIAT for yourself or your child, please speak to your physician to discuss eligibility, risks, and benefits of the procedure.
Before the Procedure
In order to be eligible for a TPIAT, a patient must fulfill certain clinical criteria. While outcomes of TPIAT are highly variable, experts have generated specific selection criteria in an effort to maximize the benefits of the procedure while minimizing the risks to the patient. These criteria are summarized in Table 1 below.
Your doctor will also speak to you about the benefits and risks of the procedure. The goal of a TPIAT is to eliminate the source of pain (i.e. the pancreas), while preserving as much of the original endocrine pancreatic function as possible through islet cell transplantation to the liver. As islet cells are responsible for generating insulin, a hormone that regulates blood sugar levels, there are risks associated with becoming insulin-dependent or diabetic post-surgery. Also, other medical conditions, or comorbidities, may also be at the source of your pain. Therefore, removing the pancreas may eliminate some, but not all of the associated pain. Speak to your doctor to fully understand the risks of TPIAT specific to your clinical history.
The TPIAT acronym may also be hyphenated as TP-IAT, which distinguishes the two main elements of the procedure. TP stands for total pancreatectomy, which is the complete removal of the pancreas from the body. IAT stands for islet auto-transplantation, which refers to the transplantation of the pancreatic islet tissue back into the body to preserve the function of insulin production.
Success of the procedure is dependent on several factors. Preservation of as much islet cell function as possible is important to achieve as desirable an outcome as possible. Currently, these cells are transplanted back into the patient’s liver but some cells are lost in the process. In the future, these islet cells may be transplanted into a different site in the body, and this research is ongoing [1
]. The procedure itself typically lasts between eight to ten hours [2
]. For a visual walkthrough of the steps of the procedure, please see this video from the Cincinnati Children’s Hospital.
After the Procedure
Directly following the procedure, the patient will be closely monitored in the intensive care unit (ICU). As the source of digestive enzymes (the pancreas) has been removed, the patient will be on pancreatic enzyme replacement therapy (PERT
) for the rest of their life to properly digest food and obtain nutrients. Insulin therapy will also be initiated to control blood sugar until the newly transplanted islet cells regain functionality. For some patients, insulin therapy may be gradually weaned until they are considered insulin independent. However, this is not the case for all patients. Some patients require small doses of insulin, and others require large doses of insulin for the rest of their lives.
If pain subsides, the patient may be weaned off pain medications when deemed appropriate by a physician. Additional follow up testing will be performed to monitor the functionality of the transplanted islet cells and watch for potential complications.
Pancreatitis varies in etiology (underlying cause) and severity. For some individuals, a TPIAT procedure may be appropriate, given their clinical history, genetic makeup, and comorbidities. While outcomes vary, TPIAT may alleviate the debilitating pain of CP or RAP with the best outcomes being associated with younger age and greater islet cell mass available for transplantation [1
]. If you feel a TPIAT could be a treatment option for you or your child, speak to your doctor to discuss the potential risks and benefits of the procedure.
Bellin MD, Gelrud A, Arreaza-Rubin G, et al. Total pancreatectomy with islet autotransplantation: summary of a National Institute of Diabetes and Digestive and Kidney diseases workshop. Pancreas. 2014;43(8):1163-1171. doi:10.1097/MPA.0000000000000236