Total Pancreatectomy with Islet Autotransplantation (TPIAT)

National Leaders in TPIAT Experience

Total Pancreatectomy with Islet Autotransplantation (TPIAT)

Nationwide Children’s is one of the few pediatric hospitals in the country to offer total pancreatectomy with islet autotransplantation (TPIAT), an innovative procedure designed to relieve pain and improve quality of life and to minimize risk of lifelong diabetes for children with debilitating acute recurrent or chronic pancreatitis not resolved by medical or endoscopic interventions.

In addition to offering the most experienced board-certified pediatric TPIAT surgeon in the nation and one of the most experienced islet isolation scientists in the world, our Pancreas Care team offers the best in multidisciplinary care for your child. If your family is seeking care for pancreatitis, rest assured that our program combines great clinical and surgical skill with welcoming, personalized attention throughout the evaluation and treatment process.

What is Total Pancreatectomy with Islet Autotransplantation?

TPIAT is a surgical option for select children with debilitating pain and impaired quality of life from acute recurrent or chronic pancreatitis. It is an innovative surgical procedure that combines a total pancreatectomy (removal of the whole pancreas) with islet autotransplantation (isolation of the islets that help manage blood sugar from the pancreas, followed by their transplantation into the liver via the portal vein). The procedure can provide definitive and lasting pain relief and improve quality of life. The islet autotransplantation offers a chance for insulin independence (avoiding diabetes), as well.

TPIAT at Nationwide Children’s

TPIAT has been safely performed in adults for decades and studies suggest that it is an excellent option for some children with debilitating acute recurrent or chronic pancreatitis. However, not all pediatric hospitals perform this complex operation. Nationwide Children’s is one of only a handful of pediatric hospitals in the United States with expertise in TPIAT surgery and long-term management. 

Expert islet isolation is essential to minimize the need for lifelong insulin dependency. It is critical to have an islet isolation team with advanced experience, like that available at Nationwide Children’s — one of the only pediatric hospitals in the United States with a dedicated, on-site islet isolation facility.

Our team includes the most experienced board-certified pediatric TPIAT surgeon in the country, Jaimie D. Nathan, MD, who has performed more than 100 of the procedures, and one of the most experienced islet isolation scientists in the world, Balamurugan N. Appakalai, PhD. As part of your child’s diagnostic or surgical evaluation, we also make sure your child is seen by specialists in a wide range of related fields, such as gastroenterology, endocrinology, pain management, infectious disease and psychology. This ensures that your child’s health is considered in its entirety, so that the care plan we develop meets all of your child’s needs. 

No matter your child’s pancreas condition, you will have an attentive and experienced team of experts to guide you through the care plan every step of the way.

Is TPIAT Right for My Child?

Patients who are considered initial candidates for TPIAT have been experiencing 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, and may have been hospitalized numerous times for pain. TPIAT may also be beneficial in children with genetic risk factors for pancreatitis.

TPIAT is not right for every child with acute recurrent or chronic pancreatitis, however. Your child’s pancreas anatomy and vasculature will be thoroughly examined to make sure TPIAT is the best surgical option. Our expert team will consider your child’s age and whether he or she has had any other surgical procedures, together with their other health and risk factors. 

Before undergoing TPIAT at Nationwide Children’s, your child will receive a full medical and surgical evaluation. 

Learn More About the Evaluation Process

How is the Procedure Done?

The TPIAT operation is completed in two major steps: pancreas removal, followed by islet autotransplantation. At Nationwide Children’s, your child’s operation will be performed by an experienced surgical team with expertise in TPIAT and other complex abdominal surgeries. In fact, our Pancreas Care team’s surgical director is the board-certified pediatric surgeon who has performed the highest number of TPIAT operations in children in the United States.

Learn More About the Surgery

Why Nationwide Children’s?

Nationwide Children’s is one of very few pediatric hospitals in the United States offering TPIAT for children. Jaimie Nathan, MD, FACS, chief of Pediatric Abdominal Transplant and Hepatopancreatobiliary Surgery, is the nation’s most experienced board-certified pediatric TPIAT surgeon who has performed the largest number of TPIAT operations in children – more than 100. He has more than 10 years of experience providing innovative surgical care for children with pancreatic diseases. Dr. Nathan specializes in minimally invasive techniques, including laparoscopic and robotic surgery, which allows children the greatest chance at a fast recovery after surgery. 

In addition to the best in surgical expertise, our Pancreas Care team includes clinical experts in the care of all pancreatic diseases, as well as a full range of related medical and psychosocial health fields. Our clinicians lead research programs and are constantly working to improve the quality of pancreas care received by patients at Nationwide Children’s and across the country.

What else makes Nationwide Children’s Hospital different?

Our program also offers:

  • One of the nation’s only pediatric hospitals with a dedicated, on-site islet isolation facility. This allows us to provide fast, expert islet isolation and transplantation for children undergoing TPIAT. Because successful islet isolation is crucial to your child’s chance of living insulin-free after surgery, the skill of the scientists working on islet extraction — which can be very challenging with pediatric pancreases — is very important.
  • One of the world’s most experienced islet autotransplantation scientists. Our Director of Islet Cell Transplantation and Beta Cell Biology, Balamurugan Appakalai, PhD, has worked with Dr. Nathan for years. Dr. Appakalai is one of the world’s most experienced in processing pancreases for clinical islet autotransplantation. He has processed more than 1,500 pancreases for transplants and research. His lab also leads the way in research to get more islets from the pediatric pancreas, and how to make islet transplantation into the liver more effective and longer lasting.
  • Advanced insulin management expertise to support your child after surgery. Our endocrinology team specializes in identifying the best insulin monitoring techniques for each family, and educating families on glucose management. As your child recovers from surgery, you will have a team of experts to walk you through insulin care for as long as your child needs it. If your child’s islets successfully start making insulin, we will provide intensive monitoring to safely transition your child off insulin. If your child still requires partial or full insulin therapy after TPIAT, our diabetes and nutrition experts will guide you every step of the way, so that you can feel confident managing your child’s blood glucose levels at home.
  • Leadership in national and international pancreas research programs. Our team of experts does more than just day-to-day clinical and surgical care. We actively participate in research programs to improve pancreas care in the future. Our Pancreas Care program is a select participant of INSPPIRE (INternational Study group of Pediatric Pancreatitis: In Search for a cuRE), the nation’s largest research consortium dedicated to pediatric pancreatitis. We have conducted research on pancreas-on-a-chip technology, and we participate in the POST (Prospective Observational Study of TPIAT) Study, a multi-institutional grant-funded study meant to better understand and improve TPIAT. Our Pancreas Care team members have published extensively in the literature regarding pancreatitis and TPIAT in children.
  • Accreditation as both an Academic and Clinical Center of Excellence in pancreas care. Nationwide Children’s is recognized by the National Pancreas Foundation as an approved Academic and Clinical Center of Excellence. This accreditation recognizes our dedication to high-quality, multidisciplinary care and the advancement of the field through research. Centers that achieve these recognitions undergo in-depth evaluations and must meet many criteria, such as having a team of pancreas experts from many medical specialties, including gastroenterology, pancreatic surgery, interventional radiology, pain management, nutrition, psychosocial support and more.
  • Family support services that truly help out the whole family. From our Global Patient Services program for traveling families to the on-site amenities and activities we offer for parents and siblings, we’ve thought of it all. When you come to Nationwide Children’s, we make sure you can focus on your child’s health, rather than just logistics.

Our Pancreas Care team is compassionate and extremely skilled in advanced pancreatic care. If you choose Nationwide Children’s for your child’s TPIAT and pancreas care needs, you can be sure we offer an exceptional, personalized experience and the field’s leading experts.

Reach out to our Pancreas Care team today to learn more, or talk with your child’s doctor about getting a referral to Nationwide Children’s for care. We look forward to the opportunity to show you why Nationwide Children’s is the best place for your child’s pancreas care needs.