Total Pancreatectomy with Islet Auto-Transplant

What is total pancreatectomy with islet auto-transplant?

If you suffer from chronic pancreatitis, you know that the disease can be debilitating.  In some patients for whom all other treatments have failed, a total pancreatectomy with islet auto-transplant (TPIAT) can lead to a dramatic improvement in quality of life.  TPIAT removes the diseased pancreas, purifies and concentrates the islet cells (crucial for producing insulin), and then places those cells into the liver. Unlike other transplant procedures, TPIAT does not require immune suppression since it is your own islet cells being used.  While it is a serious operation with significant risk and ramifications, over 90% of patients who have TPIAT show elimination or significant reduction in pain, and up to 30-40% don’t need to use insulin every day, and are able to return to normal daily life. [Source: Pancreas. 2014 PMC4205476]

Until now Oregon patients have had to travel out of state to get the procedure.

Why OHSU

Because of its excellence in pancreatic diseases, OHSU and the Brenden-Colson Center have received National Pancreas Foundation Center designation. This designation means that we have gone through an extensive review process and meet the criteria that were developed by a task force made up of experts and patient advocates. The criteria include having the required expert physician specialties such as gastroenterologists, pancreas surgeons, and interventional radiologists, along with more patient focused programs such as a pain management service, psychosocial support and more.  The Brenden-Colson Center for Pancreatic Care provides research expertise in islet cell biology and cell isolation techniques.

Meet the team

The OHSU Brenden-Colson Center TPIAT program consists of experts in the area of Pancreatic Surgery, Gastroenterology, Diabetes Care, Anesthesiology, Pain Management, Nutrition, with the support of the Cell Transplantation Laboratory of OHSU Hospital.  It has been developed in consultation with TPIAT experts from the University of Minnesota, University of Texas Medical Branch at Galveston, and the University of Cincinnati.

Program Directors:  Dr. Brett Sheppard - Surgery; and Dr. Kaveh Sharzehi - Gastroenterology
Patient Care and Program Coordinator:  Lisa Bloker RN, BSN - Digestive Health
Surgery:  Dr. Brett Sheppard, Dr. Erin Gilbert - Surgery
Pain Management:  Dr. Andrei Sdrulla, Long Ong, NP - Anesthesiology
Psychology:  Thomas Kern, PhD - Anesthesiology
Diabetes Care:  Dr. Andrew Ahmann, Dr. Ines Guttmann-Bauman, Dr. Leah Wilson - OHSU Harold Schnitzer Diabetes Health Center
Nutrition:  Savitha Chandra - Clinical Nutrition
Cellular Processing:  specially trained laboratory technicians - OHSU Brenden-Colson Center for Pancreatic Care, in cooperation with the OHSU’s Cellular Therapy Laboratory (FDA regulated and FACT accredited for more than sixteen years)

Contact us

For patients
For appointments or other clinical matters, please contact the OHSU Digestive Health Center phone: (503) 494-4373, or your providing clinic.

For referring providers
To refer a patient to a physician at OHSU specializing in pancreatic disease or other digestive illness, please call us at any time.
24-hour OHSU Consult Service:  (800) 245-6478
OHSU Digestive Health Center:  (503) 494-4373

Considering TPIAT?

Chronic pancreatitis is inflammation of the pancreas that does not heal or improve—it gets worse over time and leads to permanent damage. Chronic pancreatitis eventually impairs a patient’s ability to digest food and make pancreatic hormones. Diabetes is a common complication of chronic pancreatitis; TPIAT is a treatment option for those patients with chronic pancreatitis who have not yet developed serious diabetes. [Source: The National Pancreas Foundation]

Have you
…experienced severe, recurring pain from pancreatitis for more than 6 months?
…required one or more hospitalizations?
…not responded to standard medical therapies?
…never smoked or quit smoking at least 6 months ago?
…stopped using alcohol or recreational drugs at least 6 month ago?

Can you
…accept the risk of developing insulin-dependent diabetes?
…make a lifelong commitment to pancreatic enzyme replacement therapy?
…follow specific pain management and nutritional instructions?

If so
   …you may be a candidate.  Our providers would be happy to meet with you to help you determine if TPIAT is right for you.  As part of your evaluation we will perform a comprehensive review of your medical history, general health and life style, and the functioning of your pancreas and islet cells.  We will also review all treatment options available to you to help you make your decision.

Before Surgery

  1. Your primary care provider sends us a referral request.
  2. Our nurse coordinator and providers review your referral and outside records.
  3. You will be contacted by our nurse coordinator to review the program and discuss arranging any additional lab tests or diagnostic imaging which may be helpful to obtain prior to or in coordination with your appointments (e.g., pancreatic function tests, pancreatic and liver enzymes, MRI and/or CT scan).
  4. Our schedulers will then contact you to arrange appointments in our pancreatitis clinic for your initial evaluation.
  5. After your initial evaluation, our nurse coordinator will make appointments with other specialists on our team (pain and pain psychology, endocrinology and nutrition).  Additional imaging with radiology or specialty consultations such as hepatology or cardiology may also be necessary.
  6. Our multidisciplinary team will then meet to discuss your case and make sure you are a candidate for the TPIAT procedure.  Note that smoking or heavy use of alcohol or IV drugs will prevent you from being a candidate.
  7. Further treatment recommendations, imaging or lab tests may be ordered as a result of the team discussion.
  8. Once we are sure this is the right option for you, your surgery will be scheduled and you will return for a pre-operative evaluation.

After Surgery

  1. You will be admitted to the hospital early in the morning the day of your scheduled surgery.  While you are in surgery and under anesthetic, your pancreas is removed and transported to our islet cell processing lab.  The islet cells are then removed from the pancreas and purified.  Once the process has been completed, these cells are transported back to the operating room and re-inserted via the portal vein that goes to your liver.
  2. Recuperation from the surgery usually consists of a hospital stay of 10-14 days.
  3. If you live outside of the Portland area you will need to stay in Portland for the first month after your hospital discharge. You will also require a family member or friend to care for you continuously during this time.
  4. There will be doctor visits 1-2 times weekly for the first month, weekly lab draws, and continual changes to your insulin and diabetes medications.  We will also closely monitor your nutrition and pain requirements during this time.  The frequency of these visits will decrease as you continue to recover.
  5. As you heal, you will begin to wean off of pain medications with your doctor’s guidance.
  6. As a result of surgery, pancreatic enzyme replacement drugs will be necessary for the rest of your life.  Our nutritional team will work with you closely to determine the correct dose.
  7. Finally you will require insulin for at least the first few months after surgery and depending on the function of your islet cells you may also need to use insulin permanently. Our endocrinology team will follow you closely during your hospital stay and recovery.  They will instruct and guide you on necessary dietary changes and your body’s changing insulin needs.
  • Pain management
    - Non-steroidal anti-inflammatories
    - Opioids
    - Celiac plexus block
  • Endoscopic placement of a stent in the pancreatic duct
  • Other surgical options
    - Combined drainage and decompression operations
    - Modified Whipple procedure
  • Antioxidant therapy (experimental)

If you feel you would benefit from TPIAT please share this information with your providers and ask them to contact our office at (503) 494-4373 to place a referral.

Our Nurse Coordinator, Lisa Bloker, RN, BSN may also be contacted at (503) 494-4373 should you or your provider have any additional questions or concerns.

Most health insurance plans cover the TPIAT procedure and associated medical costs (including lifelong drug costs), but it is your responsibility to confirm this.  Our managed care specialists will help you to make sure you are aware of your potential co-pay costs before you commit to the procedure.  Costs will include lifelong co-pays for synthetic enzymes and possibly also for insulin.

For out-of-town patients and their families, travel and lodging costs are a consideration.  Many Portland hotels offer OHSU patient families a discounted rate.  OHSU’s Gary and Christine Rood Family Pavilion provides temporary, low-cost lodging for some patients and families who travel long distances to OHSU for specialized care. For adult patients, to be eligible to stay you must have a referral from your doctor, social worker, or case manager and meet screening requirements.