# Islet Cell / TPIAT — GCMD Library living collection

Also covered as: acute recurrent pancreatitis · chronic pancreatitis · pancreas divisum · acute pancreatitis · exocrine insufficiency · portal vein thrombosis · central sensitization · delayed gastric emptying

Experts: Dr. Jamie Nathan, Dr. Joe Palermo, Dr. Deb Elder, Dr. Ken Goldschneider

Updated: n/a · 4 episodes · 89 cited statements

## Episodes
### Foundations
- [Welcome and Introductions: Pancreatic Disease](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969) — video · 6:04 · [machine version](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969.md)

### Surgical Management
- [Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973) — video · 47:20 · [machine version](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973.md)
- [Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540) — video · 10:19 · [machine version](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540.md)

### Complications
- [Pancreatitis in pediatric patients with pancreatic solid pseudopapillary neoplasms- a single center experience](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=0) Welcome and Event Logistics (Ep 1)
- [2:34](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=154) Introduction of Course Director (Ep 1)
- [3:33](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=213) Panel Introductions and Session Overview (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=0) Introduction and Case Presentation (Ep 2)
- [2:32](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=152) Imaging Review and TPIAT Indications (Ep 2)
- [4:44](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=284) Multidisciplinary Evaluation Process (Ep 2)
- [8:30](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=510) Endocrinology Assessment and Diabetes Counseling (Ep 2)
- [13:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=794) Pain Management Strategy (Ep 2)
- [19:33](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1173) Surgical Evaluation and Criteria (Ep 2)
- [25:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1549) Perioperative Pain Protocol (Ep 2)
- [26:44](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1604) Surgical Technique and Islet Isolation (Ep 2)
- [34:47](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2087) ICU Management and Early Recovery (Ep 2)
- [39:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2354) Outcomes and Long-term Management (Ep 2)
- [43:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2629) Glucose Management and Closing Remarks (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=0) Introduction and Patient Selection (Ep 3)
- [2:01](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=121) Surgical Procedure (Ep 3)
- [4:25](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=265) Islet Cell Processing (Ep 3)
- [6:28](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=388) GI Reconstruction and Islet Infusion (Ep 3)
- [7:38](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=458) Post-operative Care and Recovery (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=0) Post-resection pancreatitis risk in pediatric solid pseudopapillary neoplasms (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Solid pseudopapillary neoplasms are one of the most frequent pancreatic tumors in pediatric patients" — Lizzie Lee (epidemiological) [Ep 4 · 0:09](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=9)
- "Surgery for solid pseudopapillary neoplasms is usually curative and outcomes are excellent" — Lizzie Lee (clinical) [Ep 4 · 0:15](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=15)
- "In a single center study, 10 adolescent girls underwent surgical resection for solid pseudopapillary neoplasms" — Lizzie Lee (clinical) [Ep 4 · 0:22](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=22)
- "3 out of 10 patients developed acute recurrent or chronic pancreatitis after resection" — Lizzie Lee (clinical) [Ep 4 · 0:25](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=25)
- "Every patient who developed ongoing pancreatitis had genetic risk factors like CFTR gene variants or pancreas divisum" — Lizzie Lee (clinical) [Ep 4 · 0:32](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=32)
- "Some patients with post-resection pancreatitis ultimately required completion pancreatectomy" — Lizzie Lee (clinical) [Ep 4 · 0:40](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=40)
- "Identifying genetic and anatomic risk factors before surgery may change management of patients with solid pseudopapillary neoplasms" — Lizzie Lee (opinion) [Ep 4 · 0:48](https://library.globalcastmd.com/watch/pancreatitis-in-pediatric-patients-with-pancreatic-solid-pseudopapillary-neoplasms-a-single-center-experience-11847?t=48)
- "TPIAT is one of the most complex abdominal surgical procedures performed in children" — Juan Gurria (clinical) [Ep 3 · 0:48](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=48)
- "Surgical indications for TPIAT are for patients with either chronic or acute recurrent pancreatitis" — Juan Gurria (clinical) [Ep 3 · 0:54](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=54)
- "Patients are candidates for TPIAT when all medical and endoscopic therapy has failed" — Juan Gurria (guideline) [Ep 3 · 1:02](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=62)
- "TPIAT patients usually have a genetic mutation that drives the disease" (clinical) [Ep 3 · 1:08](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "TPIAT patients typically present with chronic debilitating pain that can lead to opioid addiction or severe impairment of their mental health" (clinical) [Ep 3 · 1:08](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "Full evaluation by the Pancreas Care Center team includes GI, social worker, endocrine, surgery, radiology, genetics, behavioral health, physical therapy, anesthesia and pain team" — Juan Gurria (clinical) [Ep 3 · 1:23](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=83)
- "Patients are prepared with vaccinations for potential splenectomy before surgery" — Juan Gurria (clinical) [Ep 3 · 1:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=109)
- "Pain catheters are placed in the transversus abdominis muscle by pain specialists" — Juan Gurria (clinical) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=160)
- "Central venous catheter placement uses ultrasound for vein puncture and fluoroscopy for appropriate insertion" (clinical) [Ep 3 · 2:46](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=166)
- "The pancreas has often been injured for years, which makes the dissection procedure quite challenging" — Juan Gurria (clinical) [Ep 3 · 3:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=194)
- "Blood supply to the pancreas is preserved until the very last moment because hypoxia of islet cells cannot be risked" — Juan Gurria (clinical) [Ep 3 · 4:06](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=246)
- "Digestive enzymes including collagenases and neutral proteases are injected into pancreatic ducts to break down extracellular matrix" — Rita Bottino (clinical) [Ep 3 · 4:51](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=291)
- "Enzyme injection turns the solid pancreas organ into liquid form by releasing islet cells and exocrine cells" (clinical) [Ep 3 · 5:24](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=324)
- "Islet number correlates with good outcome" — Rita Bottino (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=345)
- "Maximum infusion volume is 5 mL per bag with 3 bags maximum per patient" (clinical) [Ep 3 · 5:59](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=359)
- "Islet cells are suspended in medium with albumin, heparin, and antibiotics" — Rita Bottino (clinical) [Ep 3 · 6:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=374)
- "Islet cells are infused into the portal vein with the goal of implanting in the liver and producing insulin" — Juan Gurria (clinical) [Ep 3 · 7:15](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=435)
- "Portal vein pressures are constantly checked during islet infusion to prevent portal vein thrombosis" — Juan Gurria (clinical) [Ep 3 · 7:25](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Portal vein thrombosis could cause significant morbidity to the patient" — Juan Gurria (clinical) [Ep 3 · 7:25](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Patients are placed in intensive care unit to control hemodynamics and fluid shift balance" — Juan Gurria (clinical) [Ep 3 · 8:01](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=481)
- "Islet cells need to heal in a homeostatic environment" — Juan Gurria (clinical) [Ep 3 · 8:12](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=492)
- "Glucose and insulin are controlled via exogenous infusions post-operatively" — Juan Gurria (clinical) [Ep 3 · 8:18](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=498)
- "Nutrition is key in the healing of connections between the biliary tract and gastrointestinal tract" — Juan Gurria (clinical) [Ep 3 · 8:22](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=502)
- "Discharge criteria include well-controlled pain, full feeds via tube or by mouth, and well-controlled glucose via continuous glucose monitoring" — Juan Gurria (clinical) [Ep 3 · 8:39](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=519)
- "Cincinnati Children's has been leading the world in pediatric surgical education" — Todd (opinion) [Ep 1 · 0:28](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=28)
- "The event will be recorded and available after 48 hours" — Todd (clinical) [Ep 1 · 1:22](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=82)
- "A new video portal will allow keyword searching to watch specific minutes of topics rather than entire events" — Todd (clinical) [Ep 1 · 1:27](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=87)
- "The Center of Telehealth at Cincinnati Children's is used every day by experts to help other physicians and patients around the world" — Todd (clinical) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=120)
- "Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric surgeon and transplant surgeon, and surgical director of the Pancreatic Care Center" — Todd (clinical) [Ep 1 · 3:06](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=186)
- "The session will cover surgical approaches, interventional endoscopic approaches, acute pancreatitis, acute recurrent pancreatitis, chronic pancreatitis, and medical management over four hours" — Jamie Nathan (clinical) [Ep 1 · 3:38](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=218)
- "Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program" — Jamie Nathan (clinical) [Ep 1 · 4:05](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=245)
- "Ken Goldschneider is director of pain management at Cincinnati Children's and professor of clinical pediatrics and anesthesia, playing a central role in pain management for patients with pancreatic diseases" — Jamie Nathan (clinical) [Ep 1 · 4:23](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=263)
- "Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center" — Jamie Nathan (clinical) [Ep 1 · 4:40](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=280)
- "Tom Lynn is a gastroenterologist who takes care of the vast majority or all endoscopic needs in children with pancreatic disorders, director of endoscopy for the Pancreas Care Center, and co-director of endoscopy for the division of gastroenterology" — Jamie Nathan (clinical) [Ep 1 · 4:54](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=294)
- "Andrew Trout is the lead radiologist for the multidisciplinary Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine" — Jamie Nathan (clinical) [Ep 1 · 5:17](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=317)
- "Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the session" — Jamie Nathan (clinical) [Ep 1 · 5:33](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=333)
- "Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the session" — Jamie Nathan (clinical) [Ep 1 · 5:47](https://library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=347)
- "TPIAT is indicated for chronic pain unresponsive to medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes" — Joe Palermo (guideline) [Ep 2 · 4:44](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=284)
- "The main indication for TPIAT is chronic pain unresponsive to optimal medical and endoscopic approaches and significantly impaired quality of life" — Joe Palermo (guideline) [Ep 2 · 5:28](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=328)
- "Evaluation for TPIAT requires multidisciplinary assessment including gastroenterology, surgery, endocrine, pain team, human genetics, infectious disease, social workers and other ancillary services" — Joe Palermo (guideline) [Ep 2 · 6:02](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=362)
- "Social workers assess support structures, resources, and assist with school and work issues, with families away from home for at least 6 to 8 weeks for TPIAT" — Joe Palermo (clinical) [Ep 2 · 7:27](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=447)
- "Infectious disease team ensures immunizations are up to date, discusses post-splenectomy prophylaxis and management, and evaluates for MRSA colonization prior to surgery" — Joe Palermo (guideline) [Ep 2 · 7:52](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=472)
- "TPIAT benefits include improved quality of life, reduction of pain, less missed school days, participation in activities, and titration of pain medications" — Deb Elder (clinical) [Ep 2 · 8:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=511)
- "After TPIAT, patients will have an insulin dependent form of diabetes with hope for recovery and insulin independence over the course of a year, but immediately postoperatively they will need insulin" — Deb Elder (clinical) [Ep 2 · 9:00](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=540)
- "Type 3C diabetes describes a pancreatic form of diabetes that is insulin deficient, unlike type 1 diabetes which is autoimmune or type 2 diabetes which is insulin resistant" — Deb Elder (clinical) [Ep 2 · 11:05](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=665)
- "The choice of therapy in type 3C diabetes is insulin and not oral hypoglycemic agents" — Deb Elder (guideline) [Ep 2 · 11:27](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=687)
- "A normal peak insulin in response to oral glucose tolerance load is typically at 30 minutes" — Deb Elder (clinical) [Ep 2 · 12:21](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=741)
- "Tramadol is useful for moderate pain because it doesn't generally slow gut motility very much, avoiding GI slowing that occurs with conventional opioids" — Ken Goldschneider (clinical) [Ep 2 · 16:42](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1002)
- "Neuropathic medications like tricyclic antidepressants and gabapentin are used because sensitization occurs in both the enteric and central nervous system from repeated inflammatory insults" — Ken Goldschneider (clinical) [Ep 2 · 17:26](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1046)
- "Neuropathic pain from sensitization is not treated with opioids" — Ken Goldschneider (guideline) [Ep 2 · 17:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1069)
- "The primary goal of TPIAT is to relieve incapacitating pain or debilitation of acute recurrent pancreatitis, not the transplant itself" — Jamie (clinical) [Ep 2 · 20:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1231)
- "The goal of islet autotransplantation is to preserve alpha and beta cell mass as well as pancreatic polypeptide secreting cells to prevent or minimize potentially challenging diabetes" — Jamie (clinical) [Ep 2 · 21:03](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1263)
- "Brittle diabetes describes a form of diabetes with unpredictable extreme highs and extreme lows for no reason, thought to be due to lack of contraregulatory hormones when alpha cells are removed" — Deb Elder (clinical) [Ep 2 · 21:33](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1293)
- "Brittle diabetes is only reported in a small subset of type 1 diabetes patients, less than 1%, and recent studies comparing total pancreatectomy population with type 1 complications show no difference" — Deb Elder (epidemiological) [Ep 2 · 21:46](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1306)
- "Criteria for TPIAT include diagnosis of acute recurrent pancreatitis or chronic pancreatitis, chronic pain greater than 6 months duration with daily opioid use or severely impaired quality of life, absence of reversible cause, and failure of medical or endoscopic intervention" — Jamie (guideline) [Ep 2 · 23:20](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1400)
- "Contraindications to islet autotransplantation include pre-existing insulin dependent diabetes mellitus, liver disease with portal hypertension or portal vein thrombosis" — Jamie (guideline) [Ep 2 · 23:59](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1439)
- "Patients with central sensitization of pain, functional pain disorders, drug seeking behavior, or severe psychosocial maladaptation do not do as well after TPIAT" — Jamie (clinical) [Ep 2 · 24:35](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1475)
- "Perioperative pain protocol includes preoperative gabapentin, intraoperative methadone, ketamine infusion during and post-op, lidocaine infusion for first 8 hours, and dexmedetomidine infusion prior to ICU transport" — Ken Goldschneider (guideline) [Ep 2 · 25:51](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1551)
- "TPIAT involves total pancreatectomy and near total duodenectomy, preserving D1 to reduce bile reflux by creating a Roux limb and preserving the pylorus" — Jamie (clinical) [Ep 2 · 26:46](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1606)
- "Splenectomy is performed routinely for TPIAT; attempting to preserve the spleen risks warm ischemia to islets during dissection and potential spleen loss if relying only on short gastric vessels" — Jamie (clinical) [Ep 2 · 27:22](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1642)
- "Cholecystectomy and appendectomy are performed during TPIAT to prevent future complications" — Jamie (clinical) [Ep 2 · 28:01](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1681)
- "There is a relationship between islet yield and severity of chronic pancreatitic changes by imaging or histopathology" — Jamie (clinical) [Ep 2 · 29:19](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1759)
- "Insulin independence is dependent on the number of islet equivalents transplanted" — Jamie (clinical) [Ep 2 · 29:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1781)
- "Prior ductal drainage procedures and distal pancreatectomy compromise islet yield" — Jamie (clinical) [Ep 2 · 29:50](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1790)
- "Patients have delayed gastric emptying after TPIAT due to Roux limb reconstruction and pylorus preservation, which improves by about 3 to 5 weeks" — Jamie (clinical) [Ep 2 · 30:41](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1841)
- "Portal vein pressures exceeding 25 centimeters of water pressure are associated with higher risk of portal vein thrombosis post TPIAT" — Jamie (clinical) [Ep 2 · 31:45](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1905)
- "Insulin infusion is started early in the operation and is critical to maintain glycemic control post TPIAT to protect from toxic hyperglycemia" — Jamie (guideline) [Ep 2 · 32:19](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1939)
- "Islets do not resume function immediately after transplantation and rely on diffusion of nutrients and oxygen until neovascularization occurs, which takes weeks to months" — Jamie (clinical) [Ep 2 · 32:43](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1963)
- "Post-operative management includes heparin infusion for one week and dexamethasone infusion for first 2 days to decrease instant blood mediated inflammatory response" — Jamie (guideline) [Ep 2 · 33:10](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1990)
- "Tight glucose control is maintained between 80 and 120 mg/dL using continuous glucose monitoring" — Jamie (guideline) [Ep 2 · 33:28](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2008)
- "Acetaminophen is not used because some continuous glucose monitoring will read falsely with it" — Ken Goldschneider (clinical) [Ep 2 · 34:31](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2071)
- "Significant thrombocytosis occurs after TPIAT, likely not just related to splenectomy but may have mechanism based on increased thrombopoietin levels produced by hepatocytes" — Jamie (clinical) [Ep 2 · 35:49](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2149)
- "Complication rate for TPIAT is about 15 to 20%, with bleeding in 5 to 7%, and portal vein thrombosis in a handful of percent" — Jamie (epidemiological) [Ep 2 · 36:16](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2176)
- "Every patient gets a systemic inflammatory response with fevers for several days, typically resolving by post-op day 6 or 7" — Jamie (clinical) [Ep 2 · 36:29](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2189)
- "Up to 85-90% of TPIAT patients can achieve opioid independence" — Jamie (epidemiological) [Ep 2 · 37:02](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2222)
- "There is a reduction in pancreatitis type pain and severity of pain after TPIAT, with most improvement occurring over the first several months" — Jamie (clinical) [Ep 2 · 37:13](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2233)
- "40% of children achieve insulin independence after TPIAT, typically occurring over the first 12 months" — Jamie (epidemiological) [Ep 2 · 37:37](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2257)
- "30% of TPIAT patients have partial graft function requiring basal insulin, and 30% require basal-bolus insulin requirements" — Jamie (epidemiological) [Ep 2 · 37:48](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2268)
- "Best TPIAT outcomes are seen in patients under 12 years old, with up to 55% insulin independence rate" — Jamie (epidemiological) [Ep 2 · 37:57](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2277)
- "Higher replicatory capacity of islets in younger children and potential islet neogenesis of ductal origin may explain better outcomes in younger patients" — Jamie (clinical) [Ep 2 · 38:14](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2294)
- "Islet function has been shown to be durable in children for as long as 10 years post TPIAT and is especially good for patients under 21 or with short history of pancreatic disease" — Jamie (epidemiological) [Ep 2 · 38:26](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2306)
- "In Cincinnati's experience through 8 cases, there were no significant surgical complications, 4 patients are off opioids, 2 are actively weaning, 1 patient is off exogenous insulin, and 4 are aggressively weaning insulin" — Jamie (epidemiological) [Ep 2 · 38:40](https://library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2320)

## Changelog
- Aug 31: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 9 doctors auto-found from episode dossiers
- Aug 29: 9 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 5 items, 5 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 5 items, 5 dossiers, summaries for 3 audience(s)
- Aug 29: Collection generated from campaign corpus: 5 items, 5 dossiers, summaries for 1 audience(s)

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