How is the TPIAT Procedure Done?
What is TPIAT Surgery?
The TPIAT procedure 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.
Total Pancreatectomy
The first part of the procedure, the total pancreatectomy, removes the entire pancreas. At this time, our experienced surgeons rebuild the gastrointestinal tract to allow normal digestion. The appendix, gallbladder and spleen are also removed to prevent complications after surgery.
Islet Isolation
Once the pancreas is removed, the islet isolation team harvests the islets from the pancreas under sterile conditions. These islets make the hormones that regulate blood sugar levels. Nationwide Children’s is the only pediatric hospital in the country offering an on-site dedicated pancreatic islet isolation program, with one of the world’s leading experts in maximizing islets for transplantation.
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.
While the scientists are isolating the available islets from your child’s pancreas, the surgical team will be working on the reconstruction of the connections in the intestinal tract that are necessary after removal of the pancreas.
Islet Autotransplantation
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.
What to Expect After TPIAT Surgery
In the Hospital
The actual operation can last most of the day. Our care team will update your family frequently about how your child is doing. You can visit your child in the pediatric intensive care unit (PICU) after the operation is over. Your child will recover in the PICU for about one week. After that, your child will move to general recovery care for another week or two. If you wish, you may be able to sleep in a nearby room, or even in your child’s room on one of our parent beds.
While your child is at the hospital, our care team will carefully monitor your child’s glucose levels and medications to make sure your child is safe and comfortable. They will also carefully manage your child’s wound care, fluids, nutrition, breathing, and urine and abdominal drainage. Your child will need to be on a feeding tube for a period of time after operation.
As your child recovers, the transplanted islets should continue to make insulin and glucagon in the liver just like they did in the pancreas. This helps children avoid diabetes, providing natural glucose control without medication. However, it does not work right away, and some children don’t fully recover the ability to make their own insulin. Your child will need external insulin until it is clear whether the islets in the liver make enough insulin on their own for the body’s needs. During the hospital stay, your family will receive in-depth education about diabetes and managing your child’s glucose levels and related medications.
In addition, your child will require life-long enzyme replacement therapy (called PERT, or pancreatic enzyme replacement therapy) to make up for the digestive enzymes the pancreas used to make. Children undergoing TPIAT do not require anti-rejection medication, since the islets came from their own pancreas.
Our specialists in endocrinology, gastroenterology, nutrition, child life and pharmacy will make sure you understand your child’s new insulin therapy, PERT and any other medications before you go home.
After Discharge
Once your child is well enough to go home, there will be multiple follow-up appointments in the first month or two. Our Global Patient Services program can help you make arrangements for a prolonged stay in Columbus if needed.
Post-surgical follow-up will involve:
- Monitoring your child’s glucose control
- Monitoring your child’s islet function
- Adjusting medications, if needed
- Nutritional evaluation before and after the feeding tube is removed
- Reducing pain medication
No matter your child’s recovery needs and care plan, our Pancreas Care team will work with your family to make sure you are comfortable managing your child’s health. You will receive thorough training before and after discharge. We also follow up with our patients and make sure they have a care team — whether it be Nationwide Children’s or a clinic closer to their homes — ready to monitor their health long-term.
After initial recovery, your child will continue to have checkups to monitor their health, either with us or with your local gastroenterologist and endocrinologist.
Long-Term Outcomes
Most patients have a remarkable improvement in their level of pain and quality of life within the first few months after operation. Children can typically return to school and normal activities, including sports. Your child will likely be able to dramatically reduce or even eliminate narcotic pain medication use.
It will take up to a year, or sometimes longer, to know if your child will need to stay on exogenous insulin therapy, but about 40 percent of all children who undergo TPIAT will eventually be insulin-independent (non-diabetic). This percentage is higher among younger children who undergo TPIAT (about 2 in every 3 children younger than 8 years old avoid diabetes). About 40 percent of children will need just a small amount of insulin, meaning their bodies do most of the work on their own. Another 20 percent will need to replace most or all of their insulin needs with medication.
If your child does require ongoing insulin therapy, our Pancreas Care team or your child’s local endocrinologist will teach your family how to adjust the insulin therapy for your child’s needs. Your child will need ongoing occasional visits with an endocrinologist to help monitor your child for successful blood sugar control long-term.