Connections: TPIAT successfully resolves some forms of pancreatitis | Winter 2022

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Refer a patient

From the OHSU Knight Cancer Institute

Dr. Brett Sheppard

Brett C. Sheppard, M.D., is a surgical oncologist and the clinical co-director of the OHSU Brenden-Colson Center for Pancreatic Care. He is passionate about patient advocacy and focuses his research on early detection of pancreatic cancer.

Pancreatitis can be a debilitating disease, leaving patients unable to keep a job, take a vacation or even get out of bed.

For some patients, a total pancreatectomy with islet cell autotransplant (TPIAT) can lead to dramatic improvement in quality of life.

The multidisciplinary TPIAT Program at OHSU offers this surgical procedure for adults ages 16+ with hereditary, chronic or recurrent acute pancreatitis. The procedure reduces or eliminates pain for most patients, while also keeping most of them insulin independent.

TPIAT available at OHSU

A complex procedure, there are only a handful of hospitals throughout the country that offer TPIAT.

The procedure begins with a pancreatectomy. Then, the OHSU Islet Cell Processing Lab performs enzymatic dissolution of the pancreas to separate the islets, a step that takes about three to four hours.

The islet cells are then infused back into the patient via the portal vein, directly to the liver. The islets then live on in the liver and produce insulin.

Most patients recover in the hospital for about two weeks. Then our team monitors patients weekly for the next month. Patients typically begin to reap the benefit of TPIAT about six months after the procedure.

Individual results vary based on age, underlying disease and physiologic condition of the pancreas. Some patients will be insulin independent; others with severe disease may continue to need insulin supplementation. Patients with long-term chronic pain have slower pain relief. All will need pancreatic enzymes supplemented for the rest of their lives.

Pre- and post-procedure patient care

Patients referred for TPIAT get a multidisciplinary review, including surgical, medical and psychological evaluations and pain management consultation.

TPIAT patients are shepherded through our program by our nurse navigator. Patients need to reside in the Portland metro area for the first month after the procedure for weekly follow-ups. Once they return to their home communities, our program will follow them closely for the first year.

All TPIAT patients will be on insulin for the first three months after the procedure. Our team manages the weaning process for insulin and pain medication following TPIAT. All patients will have a gastric tube initially. Some patients may need the tube for gastric decompression and tube feeds; others may not.

Candidate profiles for TPIAT A subset of pancreatitis patients will benefit from TPIAT.

Most insurance plans, including Oregon Health Plan, will fund this procedure, but Medicare does not.

Who is a candidate:

  • Patients with hereditary pancreatitis. These patients are at high risk for developing pancreatic cancer. TPIAT can improve their quality of life and remove the risk for pancreatic cancer.
  • Patients with chronic or recurrent acute pancreatitis who have failed other therapies.

Who is NOT a candidate:

  • Patients who are actively drinking ethanol alcohol, using tobacco products or actively using other recreational drugs.
    • Patients must be substance-free for one year.
  • Patients who have had five years or more of chronic pain without effort to reduce opioid dependence. Even when the inciting pain source is removed, research shows that TPIAT for these patients may not result in pain relief.

When to refer

If TPIAT is an option, the earlier we see patients in this disease process, the higher the islet yield can be for better insulin independence. Our team is expert at nonsurgical care of pancreatitis and can discuss alternatives to surgery.

Patients age 16+:

  • Who have disabling chronic pancreatitis or recurrent acute pancreatitis
    • With or without a history of hereditary pancreatitis
  • Who do not have the exclusion criteria