What is total pancreatectomy with islet autotransplantation (TPIAT)?
TPIAT is a procedure with two parts: In the first part, called total pancreatectomy (TP) the surgeon removes a diseased pancreas. During the second part, the cells in the pancreas that produce the hormones that regulate blood sugar (islets) are extracted and transplanted back into the liver in a procedure called islet auto-transplant (IAT). In the liver, the islet cells start producing insulin, which minimizes or prevents diabetes.
Who is a candidate for total pancreatectomy with islet autotransplantation?
TPIAT is used to treat ongoing pancreas pain due to inflammatory pancreas conditions. It’s typically a last resort treatment for pancreas pain after other options haven’t worked.
People who have repeated attacks of acute pancreatitis may be candidates for TPIAT. Causes of these attacks include:
- Alcohol use
- Gallstones
- Hereditary or unknown (idiopathic) causes
- Injury or trauma
TPIAT evaluation
When your provider refers you to our program for consideration for TPIAT, we review your medical records carefully. If our team thinks TPIAT might be right for you, we have you come in for an evaluation.
You meet with members of our team and we conduct medical tests. We get to know you and your health history, explain what TPIAT involves, and answer your questions. If you’re a good candidate for TPIAT, we’ll schedule the procedure.
What to expect during TPIAT
The TPIAT procedure takes about six hours. We give you general anesthesia so you’re asleep and comfortable.
Your surgeon makes an incision and removes your pancreas. We send the pancreas to our lab where technicians extract islet cells. While the islet cells are being extracted, your surgeon reconstructs the areas of your digestive tract affected by pancreas removal.
When the islet cells are ready, we inject them into your liver. Your surgeon then closes all incisions with stitches.
Recovery from TPIAT
After surgery, you’ll move to the intensive care unit (ICU) and we’ll bring your loved ones in. You’ll stay in the ICU for a few days and then move to a regular hospital room.
Your total hospital stay will be about two weeks. During your time in the hospital, we closely monitor your recovery and your blood sugar to make sure the islet cells are functioning as they should. Because TPIAT uses your own islet cells, immunosuppression medication isn’t needed.
Keeping your blood sugar in a healthy range is important as you move forward after TPIAT, to allow the transplanted islets the best chance of recovering and functioning well. We’ll teach you ways to keep your blood sugar under control. We also explain what to expect as you heal from surgery and make sure you understand everything you need to know about your medications and life after TPIAT.
After your discharge from the hospital, you’ll need to stay nearby for several weeks for follow-up appointments. Local housing is available at the Clyde F. Barker Penn Transplant House. Other nearby accommodations are also available.
After you return home, we’re still here for you. We’re your partner for life, here with expert medical care and support when you need it.
Risks of TPIAT
Sometimes transplanted islet cells don’t produce enough insulin, so some people who undergo TPIAT need insulin injections. Part of our follow-up with you is blood sugar monitoring, so we can help you achieve and maintain healthy blood sugar levels.
In some cases, people who have TPIAT experience continued pain. This complication is rare, however. One year after TPIAT, 90 percent of people report improved pain levels.
Penn Medicine’s deep expertise in pancreas care and transplant procedures
As a member of the Collaborative Islet Transplant Registry (CITR) for more than 20 years, Penn Medicine is at the forefront of islet transplantation research worldwide. Our dedicated nurse coordinator has spent almost two decades compassionately guiding dozens of patients and families through this process.
The Penn Transplant Institute has a global reputation for expertise with complex transplant cases that require specialists from multiple departments. This multidisciplinary approach earned us recognition from the National Pancreas Foundation as a center for excellence in pancreas medicine. Your complete well-being is at the heart of our mission.