Total Pancreatectomy with Islet Autotransplantation (TP-IAT)

A total pancreatectomy is the removal of the entire pancreas. Pancreatectomy can be used to treat severe forms of pancreatitis or pancreatic cancer. Most people who have had total pancreatectomy and autologous islet cell transplantation for pancreatitis find a dramatic improvement in their abdominal pain. The use of narcotic pain medicine is eliminated in 70 percent of patients.

Autologous islet cell transplantation (IAT) is a procedure that is performed to prevent diabetes or reduce the severity of diabetes after removal of the pancreas (pancreatic resection). After pancreatic tissue is removed during surgery, insulin-producing islet cells are immediately isolated from the pancreas in a lab. These islet cells are then transplanted into the patient's liver through a major blood vessel called the portal vein. The islet cells continue to produce insulin to control blood sugar levels in the body.

Other names for autologous islet cell transplantation include:

• Autotransplantation of islet cells
• Autoislet transplantation
• Islet autotransplantation

The pancreas is a large gland located behind the stomach. One of the key duties of the pancreas is to produce the hormones insulin and glugagon to metabolize sugars (glucose) in the blood. The cells in the pancreas that produce these hormones are called islet cells. Insulin is needed by the body to convert blood sugars into energy. Without insulin, there is a build-up of sugar in the blood. Diabetes occurs when the body does not produce enough insulin, leading to an increased glucose level in the blood. Most patients experience dramatic pain relief after total pancreatectomy with IAT.

When the pancreas is removed, the body loses its ability to produce insulin, so diabetes will occur. Typically, the form of diabetes that occurs after pancreas resection — known as brittle diabetes — is very severe and difficult to control. Managing it may require frequent glucose monitoring and insulin administration. Moreover, brittle diabetes can lead to hypoglycemia episodes, heart and kidney disease, vision problems, poor circulation, foot conditions and/or neuropathy. Some of these complications can be life-threatening.

Physicians can prevent or reduce the effects of diabetes after pancreas removal by performing autologous islet cell transplantation. Benefits of autologous islet cell transplantation include:

• Approximately 30 to 40 percent of patients who have IAT will not require insulin treatment after the first year or two. For the 60 percent of people who do require insulin, their diabetes is typically much more easily managed.
• In people who already have diabetes, IAT decreases the chance for the development of very difficult-to-control brittle diabetes
• Prevention or reduced risk for the development of diabetes in patients who did not have it before

Because the islet cells used in this procedure belong to the patient, there is no risk for immune reactions.

Benefits of IAT

Although IAT has been performed for more than 25 years, there is only limited data on long-term results for patients who have had the procedure. Current information suggests that there is a slow, steady decline of transplanted islet function over many years after the procedure, but that significant and beneficial islet function persists for 10 years and even longer after the original operation. This experience should be balanced against the observation that as many as 50 to 80 percent of patients with chronic pancreatitis may develop diabetes within years, regardless of medical and surgical therapy.

Each case is different, and multiple factors affect the level of insulin independence a patient will experience. Studies show that these factors include the following:

• The condition of the pancreas at the time of the procedure, including the type of prior operations that may have been carried out. These factors affect the amount of islet cells that can be transplanted. A certain amount of healthy islet cells are required.
• The overall health of the patient and presence of other diseases that may affect outcome
• The patient's body mass index (BMI); people with a BMI below 30 have a greater chance of not needing insulin

People who are candidates for autologous islet cell transplantation include:

• Patients with debilitating pain from chronic pancreatitis
• Patients who experience multiple episodes of acute pancreatitis (particularly those with underlying genetic conditions) and other treatment options are unsuccessful

Autologous means that patients are receiving their own tissue for transplant. Allogeneic refers to the transplantation of tissue from one person to another.

Allogeneic islet transplantation is not used to prevent Type 1 diabetes — it is used to treat it when is it already present. It is being studied as an alternative to whole-organ pancreas transplant for people with severe diabetes. In this procedure, islet cells are taken from a cadaver pancreas and then isolated and transplanted through the portal vein into the patient's liver. There is no surgery required. Because the islet cells came from a donor organ, the patient will require immunosuppressive therapy after treatment.

Learn more about allogeneic islet cell transplantation

UChicago Medicine is one of the select few hospitals in the nation that is performing both autologous and allogeneic islet cell transplantation.