What Is TPIAT?
Total pancreatectomy with islet autotransplantation (TPIAT) is a complex surgical procedure to relieve debilitating pain in children and adolescents with acute recurrent or chronic pancreatitis. The operation occurs in two stages.
Stage one is the removal of the pancreas, spleen and most of the duodenum (part of the small intestine), followed by reconstruction of the gastrointestinal tract. The primary goal of removing the pancreas is to relieve the severe abdominal pain and other conditions. However, without a pancreas, a patient would develop insulin-dependent diabetes.
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. Next, the surgeon injects them into the liver. 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.
Why Do You Remove the Pancreas?
Removing the pancreas relieves the pain associated with acute recurrent or chronic pancreatitis. However, the pancreas releases insulin and glucagon, which are critical to control blood sugar levels. By isolating islet cells and autotransplanting them into the liver, the liver carries on the role of insulin secretion in place of the pancreas.What Is the Long-Term Outcome After TPIAT?
After surgery, the autotransplanted islets continue to make insulin and glucagon in the liver just like they did in the pancreas. This helps the child avoid diabetes, providing natural glucose control without medication.
Is TPIAT Right for My Child?
TPIAT is not for every child who has acute recurrent or chronic pancreatitis. Children who are considered initial candidates for TPIAT have experienced abdominal pain for more than six months and have a significantly reduced quality of life. They are often unable to attend school or be active. They may have been hospitalized numerous times for pain.
Before your child is considered a candidate for TPIAT at Nationwide Children’s, they receive a full medical and surgical evaluation. Testing may include:
- Blood work to check the function and health of their pancreas, liver and kidneys
- Imaging such as computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound
- Endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) to examine their pancreatic and ductal anatomy. ERCP may be used to examine the anatomy or to correct narrow biliary or pancreatic ducts
- Nutrition and enzyme evaluations to check the response of the pancreas to food
- Genetic testing to check for risk factors for pancreatitis
Speak With Our Team
Our Pancreas and Liver Care Center team reviews every child’s case to ensure they receive the right therapy for their needs. Our team includes the most experienced board-certified pediatric TPIAT surgeon in the country and one of the most experienced islet isolation scientists in the world.
Whether you're seeking a second opinion or looking to find out if TPIAT is right for your child, fill out the form below to be contacted by our team.