TP-IAT IS TRANSFORMING THE LIVES OF PATIENTS SUFFERING FROM CHRONIC PANCREATITIS
For many patients suffering from chronic pancreatitis, a total pancreatectomy (removal of the pancreas) with islet auto-transplantation (TP-IAT) can provide significant pain relief with the potential for long-term glycemic control. A TP-IAT begins with the surgeon performing an operation in which the patient’s pancreas (the source of pain and inflammation) is removed. The organ is then transported to a clean room facility where the islets are isolated from the diseased tissue via enzymatic digestion and mechanical dissociation by a team of scientists. Islets are small clusters of pancreatic cells responsible for managing blood glucose levels via glucagon and insulin secretion. The islets can then be administered back into the patients liver or peritoneal cavity where they can resume their metabolic function, producing insulin to regulate blood sugar. The goal is to maximize the number of viable islets that engraft after administration to prevent brittle diabetes. TP-IAT is becoming a more prevalent option for chronic & acute recurring pancreatitis patients and is covered by the majority of major commercial health insurers, many state Medicaid carriers, and Veteran’s Affairs.
Most patients with chronic pancreatitis (nearly 80%) will eventually develop diabetes as the disease progresses and the pancreas degenerates. Pancreatic inflammation and fibrosis, partial resections, and drainage operations all reduce the number and viability of islets remaining in the pancreas. These are all factors to consider when delaying the use of TPIAT as it may not be the best option for the patient. Additionally, delaying the procedure leaves the patient continuing to endure high levels of pain and chronic opioid use. TP-IAT may be considered earlier in the course of the disease to preserve islet function and improve long term outcomes.
There are many research papers on TPIAT and as the research continues, the goal is to determine when TPIAT should be performed and the best population for this type of procedure. Some data supports the use of TPIAT earlier in a patient’s treatment continuum than initially thought because of better possible pain relief and insulin independence rates. Data supports the fact that islet cell preservation is likely to be better earlier in the disease course, which is critical for diabetes prevention and central sensitization is less likely to have developed.
Not every patient who undergoes TP-IAT will achieve blood sugar control and some patients may require life-long insulin therapy. All patients will require life-long enzyme replacement therapy. TP-IAT is a major surgery and carries significant risks. You should speak to your doctor about the potential benefits and risks associated with TP-IAT procedure.
WHO IS ELIGIBLE FOR TPIAT? WHERE CAN IT BE PERFORMED?
TPIAT is intended for children and adults with chronic pain due to chronic pancreatitis and whose islets produce insulin. Generally, eligibility for TP-IAT is determined by abdominal pain longer than six months, severely impaired quality of life, repeated hospitalizations, and a consistent need for narcotic pain medication. Your health provider may be able to perform TP-IAT if they have the requisite surgical and endocrinology capabilities. Some doctors may prefer to refer you to a specialized surgical center.