What is TPIAT?
When other medical and surgical treatments have been exhausted, Total Pancreatectomy with Islet Auto transplant (TPIAT) is a surgical option that can treat the root cause of pain due to chronic pancreatitis (CP) or in some cases, severe recurrent acute pancreatitis.
Total pancreatectomy (TP) surgery removes the painful, diseased pancreas. The pancreas is sent to a specialized lab where the insulin producing cells (islets) are extracted. The islet cells are saved and transplanted back into the person’s liver in a procedure called islet auto-transplant (IAT). The goal is for the islets to produce insulin and prevent or minimize brittle diabetes, which would occur if only the TP was performed.
Who Might Benefit from this Procedure?
The procedure is intended to relieve pain from pancreatitis and help restore a patient’s quality of life.
Patients with repeated attacks of acute pancreatitis caused by gallstones, alcohol use, smoking, trauma, hereditary or idiopathic (unknown) causes sometimes develop chronic pancreatitis (CP). In addition to severe abdominal pain, symptoms may include discomfort when eating, digestive issues, fatty stools or diarrhea as a result of permanent damage to the pancreas. This can lead to chronic pain, weight loss, frequent utilization of health care resources and risk of diabetes and sometimes cancer. It is a long term condition that tends to get worse over time.
90 percent of people who undergo TPIAT surgery report improved pain at one year. How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis? - PMC (nih.gov)
A patient maybe referred for an evaluation by their provider if all other treatments have failed for CP or recurrent acute pancreatitis, to learn if TPIAT might be a solution.
What to Expect?
Referral
Once referral is made, medical records and imaging will be reviewed to make sure they are complete and to determine if the patient is a candidate for evaluation before any appointments are made. At that time, we will also confirm the suitability of the patient’s insurance coverage for the evaluation and any possible surgery.
Evaluation
The evaluation will be coordinated to take place over a couple of days and include blood tests and any needed imaging or procedures. At which time, the patient will meet with our team of specialists including:
- Gastroenterologist
- Pain Management specialist
- Health psychologist/psychiatrist
- Surgeon
- Endocrinologist
- Social worker
- Nutritionist
- Social Worker
- Nurse Care Coordinator
Once the evaluation is complete, the multidisciplinary team will meet to review the case and determine if the patient is a candidate for TPIAT or any other treatment options.
Surgery
Once the candidate is approved for TPIAT and agrees, the surgery can take place. The surgeon will remove the damaged pancreas (TP). The pancreas will be sent to the laboratory for processing while the surgeon performs reconstruction of the digestive tract. The surgery takes about 6 hours. The islets will be returned and infused into the liver in a procedure called Islet Auto Transplant (IAT).
In- Hospital Recovery
Patients are usually in the hospital for 10 to 14 days, initially in the intensive care unit and then on our transplant in-patient floor, “11 Pavilion”. Our team of surgeons, endocrinologists, and pain management specialists will closely monitor the patient’s progress. During the hospital stay, the patient will receive diabetic education to teach them how to keep their blood sugar under tight control. This allows the islets the best chance of recovery and long-term function.
Aftercare
Once discharged from the hospital, the patient must stay close to the hospital and clinics for several weeks as there are multiple follow up appointments. There is local housing available including the Clyde F. Barker Penn Transplant House. Once the patient returns home, they will continue to have follow up appointments with their team of specialists.
Meet the Team
- Ronald Parsons, MD
- Samir Abu-Gazala, MD
- Major Kenneth Lee, IV, MD, PhD
- James F. Markmann, MD, PhD
- Ali Naji, MD, PhD
- Nuzhat Ahmad, MD
- Michael R. Rickels, MD, MS
- Russell Bell, MD
- Robert Weinrieb, MD
- K. Louise Berry, BSC, RN, Nurse Care Coordinator
- Lauren Tempesta, MSW, Social Worker
- Domenica Caporusso, MPH, RDN, LDN, Dietician
Why Choose Penn Medicine?
Penn Medicine is recognized by the National Pancreas Foundation as a center of excellence for its multidisciplinary care of patients with pancreas disease.
Our surgeons have performed more than 150 of these procedures and our nurse care coordinator has cared for TPIAT patients for over 15 years.
Penn Medicine has been an active member of the Collaborative Islet Transplant Registry (CITR) since its establishment in 2001.
The mission of CITR is to expedite progress and promote safety in islet/beta cell transplantation. Penn Medicine’s Dr. Michael Rickels is part of the executive committee for CITR.
For more information on an evaluation appointment contact:
K. Louise Berry, RNCC at 215-662-3304 or via email at TPIAT@pennmedicine.upenn.edu.