TPIAT may be a suitable option for some children with acute recurrent or chronic pancreatitis. 

The Pancreas and Liver Care Center team evaluates each child's medical history to determine if TPIAT is the right treatment option. Here are some frequently asked questions about TPIAT surgery and treatment at Nationwide Children's.

TPIAT Surgery FAQs

What is TPIAT?

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.

Is TPIAT safe for children?

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.

How is TPIAT surgery performed?

The TPIAT operation is completed in two major steps: pancreas removal, followed by islet autotransplantation.

1. The first part of the procedure, the total pancreatectomy, removes the entire pancreas. At this time, our experienced surgeons reconstruct the gastrointestinal tract to allow normal digestion. The appendix, gallbladder and spleen are also removed to prevent complications after surgery.
2. Once the pancreas is removed, the islet isolation team harvests the islets from the pancreas. These islets make the hormones that regulate blood sugar levels. These islets include alpha and beta cells. Alpha cells make glucagon, which raises glucose/sugar in the blood. Beta cells make insulin, which lowers glucose/sugar in the blood. Once the islets are isolated from other cells of the pancreas, they are returned to the patient through an injection into the portal vein of the liver.

How It Works

Who is the surgeon performing TPIAT?

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. Jaimie D. Nathan, MD, the surgical director of the Pancreas Care team, holds the distinction of being the most experienced board-certified pediatric surgeon in the United States, having performed over 100 TPIAT operations.

Meet Dr. Jaimie Nathan

What is islet autotransplantation?

Islets make the hormones that regulate blood sugar levels. Our expert scientists isolate the available islets from your child’s pancreas. These islets include alpha and beta cells. Alpha cells make glucagon, which raises glucose/sugar in the blood. Beta cells make insulin, which lowers glucose/sugar in the blood. Nationwide Children’s offers an on-site dedicated pancreatic islet isolation program, led by Balamurugan (Bala) Appakalai, PhD, one of the most experienced islet isolation scientists.

Does every child with acute recurrent or chronic pancreatitis need TPIAT?

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. They may have been hospitalized numerous times for pain. TPIAT may be a suitable option for some children with acute recurrent or chronic pancreatitis. The 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 they had any other surgical procedures, together with other health and risk factors.

How does the team decide who would be a candidate for TPIAT?

Each referral is carefully reviewed by the full TPIAT team. While not every patient would benefit from TPIAT, every patient seen by our team will be evaluated to make sure they receive the right therapy.

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Appointment and Referral FAQs

I don’t live in Ohio. Can my child be treated at the Pancreas and Liver Care Center at Nationwide Children’s?

Yes. Nationwide Children's is among a select few centers in the United States that performs TPIAT in children. Nationwide Children’s provides care to families from around the globe. We have a full team who can help coordinate your care, travel and lodging.

How long do we have to wait for an appointment?

Once you complete the form, someone from our team will contact you within two business days to discuss your child’s condition. Our team will help you figure out what to do next.

Do I need a referral from my child’s doctor for an evaluation?

You do not need a referral to speak with our team about TPIAT. Fill out the form and someone from our team will contact you.

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