TPIAT: Relief for Patients with Acute Recurrent and Chronic Pancreatitis

Total pancreatectomy with islet autotransplantation (TPIAT) is a specialized surgical treatment for patients diagnosed with acute recurrent or chronic pancreatitis. If your child is suffering from debilitating pancreatitis, TPIAT may help and allow them to return to normal activities without pain.

What Is TPIAT?

TPIAT is a complex surgical procedure to relieve debilitating pain in children and adolescents with acute recurrent or chronic pancreatitis. The operation takes 10 to 12 hours and occurs in two stages:

1. Stage one is total pancreatectomy (removal of the pancreas), splenectomy (removal of the spleen), cholecystectomy (removal of the gallbladder), and appendectomy (removal of the appendix) followed by reconstruction of the gastrointestinal tract. The primary goal of removing the pancreas is to relieve the severe abdominal pain that accompanies acute recurrent or chronic pancreatitis. However, without a pancreas, patients develop insulin-dependent diabetes.
2. Stage two is the islet isolation and autotransplantation. Islet cells live in the pancreas where they produce insulin and other hormones that regulate blood sugar. After the surgeon removes the pancreas, the islet processing team isolates the islets from the diseased pancreas. This process can take four to five hours. When the isolated islets are returned to the operating room, the surgeon injects them into the liver via the portal vein. The goal is for the transplanted islets to begin producing insulin in the liver. This can lessen or even eliminate the patient’s risk of long term insulin-dependence. However, it can take several months to know if the islets will function adequately. In the meantime, patients are treated with “exogenous” insulin – a medication produced by a pharmaceutical company. Exogenous insulin can be given by injection or insulin pump.

Who Is a candidate for TPIAT?

Patients with severe, debilitating pain or poor quality of life caused by acute recurrent or chronic pancreatitis may benefit from TPIAT.

Patients who undergo TPIAT typically have been experiencing pain for more than six months, have failed medical and endoscopic approaches to treatment, and are no longer able to participate fully in school or other activities due to pancreatitis.

Multidisciplinary Team

Nationwide Children’s Hospital is one of few pediatric institutions in the country offering total pancreatectomy with islet autotransplantation (TPIAT) to children and adolescents.

Led by the country’s most experienced pediatric TPIAT surgeon, our pediatric specialists have years of experience managing pancreatic disease in children and adolescents. During our comprehensive evaluation process, our team will provide counseling and support while your family makes the best decision for your child.

Our multidisciplinary team consists of surgeons, pediatric gastroenterologists, advanced endoscopists, endocrinologists, pain management specialists, infectious disease specialists, clinical psychologists, and radiologists. Additional support is provided by nurse practitioners, registered nurses, social workers, genetic counselors, registered dietitians and diabetes educators.

Islet isolation is provided by scientists who are among the world’s most experienced in processing human pancreases for clinical islet transplantation, increasing the likelihood for insulin independence following TPIAT.