Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center
With Dr. Juan Pablo Gurria & Dr. Rita Bottino · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
TPIAT is one of the most complex abdominal surgical procedures performed in children
Surgical indications for TPIAT are for patients with either chronic or acute recurrent pancreatitis
Patients are candidates for TPIAT when all medical and endoscopic therapy has failed
TPIAT patients usually have a genetic mutation that drives the disease
TPIAT patients typically present with chronic debilitating pain that can lead to opioid addiction or severe impairment of their mental health
Full evaluation by the Pancreas Care Center team includes GI, social worker, endocrine, surgery, radiology, genetics, behavioral health, physical therapy, anesthesia and pain team
Patients are prepared with vaccinations for potential splenectomy before surgery
Pain catheters are placed in the transversus abdominis muscle by pain specialists
Central venous catheter placement uses ultrasound for vein puncture and fluoroscopy for appropriate insertion
The pancreas has often been injured for years, which makes the dissection procedure quite challenging
Blood supply to the pancreas is preserved until the very last moment because hypoxia of islet cells cannot be risked
Digestive enzymes including collagenases and neutral proteases are injected into pancreatic ducts to break down extracellular matrix
Enzyme injection turns the solid pancreas organ into liquid form by releasing islet cells and exocrine cells
Islet number correlates with good outcome
Maximum infusion volume is 5 mL per bag with 3 bags maximum per patient
Islet cells are suspended in medium with albumin, heparin, and antibiotics
Islet cells are infused into the portal vein with the goal of implanting in the liver and producing insulin
Portal vein pressures are constantly checked during islet infusion to prevent portal vein thrombosis
Portal vein thrombosis could cause significant morbidity to the patient
Patients are placed in intensive care unit to control hemodynamics and fluid shift balance
Islet cells need to heal in a homeostatic environment
Glucose and insulin are controlled via exogenous infusions post-operatively
Nutrition is key in the healing of connections between the biliary tract and gastrointestinal tract
Discharge criteria include well-controlled pain, full feeds via tube or by mouth, and well-controlled glucose via continuous glucose monitoring