Islet Cell / TPIAT
Also covered as: acute recurrent pancreatitis Β· chronic pancreatitis
Educational content from recorded physician discussions β not medical advice. Always talk to your child's care team about your child's situation.
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Fundamentals
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Welcome and Introductions: Pancreatic Disease
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Dr. Todd Ponsky introduces the event onacute pancreatitis, recurrent and chronic pancreatitis, exocrine insufficiency, interventional procedures as well as surgical indications for the diseased pancreas in children, culminating with a state
video6:04 Β· Jan 2019
Surgical Management
2 items
Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease
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Dr. Jaimie Nathan introduces the session, covering indications for total pancreatectomy with islet auto-transplantation(TPIAT), pre-TPIAT evaluation, pre- and post-operative management, and long-term follow-up.Dr. Joe Palermopresents a chro
video47:20 Β· Jan 2019
Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center
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In this video, we take you through a Total Pancreatectomy with Islet Autotransplantation (TPIAT)βone of the most complex abdominal surgeries performed in children. Learn about who qualifies for TPIAT, the surgical process, and the critical
video10:19 Β· Dec 2024
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Total pancreatectomy with islet autotransplantation (TPIAT) is indicated for chronic pain unresponsive to medical and endoscopic therapy or significantly impaired quality of life from acute recurrent pancreatitis [e973-c1, e973-c2]. The procedure involves total pancreatectomy with near-total duodenectomy, splenectomy, and portal vein infusion of autologous islets isolated via collagenase digestion [e973-c22, e973-c23, e10147-c21]. Portal pressures exceeding 25 cm HβO carry tenfold increased thrombosis risk . Perioperative protocols include methadone, ketamine, lidocaine infusions, heparin for one week, and dexamethasone to blunt instant blood-mediated inflammatory response [e973-c21, e973-c32, e10147-c23]. Complication rates approximate 15β20%, with bleeding in 5β7% and portal vein thrombosis in a handful of percent . Up to 85β90% achieve opioid independence, and 40% of children reach insulin independence by 12 months, rising to 55% in those under 12 years [e973-c38, e973-c40, e973-c42]. Younger children demonstrate superior beta-cell replicatory capacity and possible ductal neogenesis [e973-c43, e10147-c30]. Prior ductal drainage or resection reduces islet yield by approximately 50%, and genetic factorsβparticularly PRSS1 mutationsβcorrelate with disease severity and cancer risk [e10147-c32, e10147-c41, e10147-c42, e10147-c43]. Insulin independence correlates with islet yield >5000 IEQ/kg, though HOMA-Ξ² and microRNA-375 may offer superior prediction [e10147-c28, e10147-c36, e10147-c37].
- TPIAT achieves 85β90% opioid independence and 40% insulin independence in children, with best glycemic outcomes (55%) in patients under 12 years old.
- Portal vein pressure changes >25 cm HβO during islet infusion carry tenfold increased thrombosis risk; complication rate is 15β20%.
- Prior Puestow or distal pancreatectomy reduces islet yield by ~50%, lowering insulin-independence probability but not contraindicating TPIAT.
- Perioperative dexamethasone and heparin infusions mitigate instant blood-mediated inflammatory response; all patients experience delayed gastric emptying for 3β5 weeks.
- PRSS1 mutations carry 40% cancer risk by age 50, lowering threshold for intervention; genetic screening identifies risk factors in 68% of chronic pancreatitis patients.
For patients & families
When a child has severe, ongoing pancreas pain that doesn't get better with medicine or other treatments, doctors may talk about a surgery called TPIAT β total pancreatectomy and islet auto-transplantation. The main goal is to stop the pain that keeps children from school, activities, and normal life. During the operation, surgeons remove the entire pancreas and collect special cells called islets that make insulin. These islet cells are then put back into the child's liver, where they can start making insulin again. Before surgery, a team of many specialists β doctors, social workers, pain experts, and others β carefully evaluates whether TPIAT is the right choice. After surgery, all children will need insulin at first because the transplanted islets take time to start working. Over the first year, about 40% of children can stop needing insulin shots, and most children are able to stop taking pain medicines. Younger children tend to have better results. The operation is complex and recovery takes several weeks, but for many families it offers hope for a life without constant pain.
When a child has severe, ongoing pancreas pain that doesn't get better with medicine or other treatments, doctors may talk about a surgery called TPIAT β total pancreatectomy and islet auto-transplantation. The main goal is to stop the pain that keeps children from school, activities, and normal life. During the operation, surgeons remove the entire pancreas and collect special cells called islets that make insulin. These islet cells are then put back into the child's liver, where they can start making insulin again. Before surgery, a team of many specialists β doctors, social workers, pain experts, and others β carefully evaluates whether TPIAT is the right choice. After surgery, all children will need insulin at first because the transplanted islets take time to start working. Over the first year, about 40% of children can stop needing insulin shots, and most children are able to stop taking pain medicines. Younger children tend to have better results. The operation is complex and recovery takes several weeks, but for many families it offers hope for a life without constant pain.
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Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center
TPIAT is one of the most complex abdominal surgical procedures performed in children
clinicalJuan Gurria0:48 β
Surgical indications for TPIAT are for patients with either chronic or acute recurrent pancreatitis
clinicalJuan Gurria0:54 β
Patients are candidates for TPIAT when all medical and endoscopic therapy has failed
guidelineJuan Gurria1:02 β
TPIAT patients usually have a genetic mutation that drives the disease
clinical1:08 β
TPIAT patients typically present with chronic debilitating pain that can lead to opioid addiction or severe impairment of their mental health
clinical1:08 β
Full evaluation by the Pancreas Care Center team includes GI, social worker, endocrine, surgery, radiology, genetics, behavioral health, physical therapy, anesthesia and pain team
clinicalJuan Gurria1:23 β
Patients are prepared with vaccinations for potential splenectomy before surgery
clinicalJuan Gurria1:49 β
Pain catheters are placed in the transversus abdominis muscle by pain specialists
clinicalJuan Gurria2:40 β
Central venous catheter placement uses ultrasound for vein puncture and fluoroscopy for appropriate insertion
clinical2:46 β
The pancreas has often been injured for years, which makes the dissection procedure quite challenging
clinicalJuan Gurria3:14 β
Blood supply to the pancreas is preserved until the very last moment because hypoxia of islet cells cannot be risked
clinicalJuan Gurria4:06 β
Digestive enzymes including collagenases and neutral proteases are injected into pancreatic ducts to break down extracellular matrix
clinicalRita Bottino4:51 β
Enzyme injection turns the solid pancreas organ into liquid form by releasing islet cells and exocrine cells
clinical5:24 β
Islet number correlates with good outcome
clinicalRita Bottino5:45 β
Maximum infusion volume is 5 mL per bag with 3 bags maximum per patient
clinical5:59 β
Islet cells are suspended in medium with albumin, heparin, and antibiotics
clinicalRita Bottino6:14 β
Islet cells are infused into the portal vein with the goal of implanting in the liver and producing insulin
clinicalJuan Gurria7:15 β
Portal vein pressures are constantly checked during islet infusion to prevent portal vein thrombosis
clinicalJuan Gurria7:25 β
Portal vein thrombosis could cause significant morbidity to the patient
clinicalJuan Gurria7:25 β
Patients are placed in intensive care unit to control hemodynamics and fluid shift balance
clinicalJuan Gurria8:01 β
Islet cells need to heal in a homeostatic environment
clinicalJuan Gurria8:12 β
Glucose and insulin are controlled via exogenous infusions post-operatively
clinicalJuan Gurria8:18 β
Nutrition is key in the healing of connections between the biliary tract and gastrointestinal tract
clinicalJuan Gurria8:22 β
Discharge criteria include well-controlled pain, full feeds via tube or by mouth, and well-controlled glucose via continuous glucose monitoring
clinicalJuan Gurria8:39 β
Welcome and Introductions: Pancreatic Disease
Cincinnati Children's has been leading the world in pediatric surgical education
opinionTodd Ponsky0:28 β
The event will be recorded and available after 48 hours
clinicalTodd Ponsky1:22 β
A new video portal will allow users to search by keyword and watch specific segments rather than entire events
clinicalTodd Ponsky1:27 β
The Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world
clinicalTodd Ponsky2:00 β
Cincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists
clinicalTodd Ponsky2:38 β
Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's
host_summaryTodd Ponsky3:06 β
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