Total Pancreatectomy with Islet Autotransplantation (TPIAT)
There is a new surgery in pediatrics that has been developed over the last few years. When I worked in Cincinnati, I heard about pediatric surgeons being able to remove the pancreas and moving the islet cells to the liver. Now, why would you want to do this? This surgery was developed for patients with acute recurrent or chronic pancreatitis and it has been successful in helping them improve their quality of life and reduce their pain. Those eligible for the surgery are in so much pain they cannot go to school or be active and have been hospitalized several times for their condition. It is also used for those that have somehow damaged the organ and it is an option to remove it but not lose insulin-producing ability. This was a surgery developed and aftercare protocol made at Cincinnati Children's Hospital.
During the surgery, the team has to remove the pancreas and reconstruct the gastrointestinal tract. They have a lab in the operating room that processes the pancreatic tissue and isolates the islet cells. “This specially designed operating room is to minimize the time the organ goes without blood flow which is important to maximize islet cell yield” (Saint-James, 2021). The pathologist examines them to ensure no abnormalities and the cells are then infused into the liver. These cells show that they can eventually resume function and produce insulin. After this surgery, there is a lengthy stay in the PICU (pediatric intensive care unit) where a large team must follow protocol precisely to ensure the patient recovers successfully. This is a large undertaking for the patient and their family, and also those involved in their medical care. However, results show that patients can be partially or completely independent of needing to take insulin over time. “Approximately two-thirds of patients under 8 do not need to take insulin at one year after their operation” (Cincinnati Children's, 2020). This surgery has been a resounding success and will be taught at many more hospitals in the future. This surgery helps people get off of their opioid pain medication and significantly improves the quality of life at all ages.
Cincinnati Children's. (2020). Retrieved November 22, 2022, from https://www.cincinnatichildrens.org/service/p/pancreas-care/treatments/tpiat
Saint-James, M. (2021, September 23). TPIAT process: Johns Hopkins Children's center. TPIAT Process | Johns Hopkins Children's Center. Retrieved November 22, 2022, from https://www.hopkinsmedicine.org/johns-hopkins-childrens-center/what-we-treat/specialties/gastroenterology-hepatology-nutrition/programs-centers/tpiat/tpiat-process.html
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