Multidisciplinary Team Performs Total Pancreatectomy with Islet Cell Autotransplantation for Select Patients with Chronic Pancreatitis

At Brigham and Women鈥檚 Hospital (BWH), a multidisciplinary team including gastroenterologists, gastrointestinal surgeons, transplant surgeons, endocrinologists, nutritionists, and a range of other specialists has successfully performed a series of total pancreatectomy with islet cell autotransplantation (TPIAT) procedures since 2013 for the treatment of patients with severe chronic pancreatitis. BWH is among a select number of hospitals nationwide to offer TPIAT.

鈥淢ost patients with chronic pancreatitis can be treated with conservative management and, occasionally, with advanced endoscopic procedures or surgery to decompress the pancreatic duct or remove a portion of the pancreas. Select patients, however, continue to have significant disabling symptoms,鈥� said Thomas Clancy, MD, Associate Director for Pancreatic Cancer in the Division of Surgical Oncology at BWH. 鈥淩emoval of the entire pancreas, along with islet cell autotransplantation to mitigate the effects of endocrine pancreatic insufficiency, offers prolonged improvements in quality of life and pain relief in these patients.鈥�

Collaborative Refining of Protocols and Procedures

The multidisciplinary team meets monthly to discuss possible patients for TPIAT, to review processes, and to assess the progress of patients who have undergone TPIAT. The team has modified its procedures for pancreatic resection and autotransplantation following extensive discussion with colleagues nationwide. The team also has developed protocols to assess the function of the islets in transplanted patients to monitor the patients鈥� ability to achieve insulin independence over time.

Evaluating Outcomes

As the patients who undergo TPIAT have to adapt to new physiologic and psychosocial challenges after a history of chronic pain and malnutrition, they continue to benefit from coordinated multidisciplinary care, including gastroenterologists, surgeons, endocrinologists, pain psychiatrists, social workers, nutritionists, and case managers. The BWH team has seen numerous positive results among the patients who have undergone TPIAT, including:

• Evidence of islet transplant function in all patients*;
• Improvement in symptoms and quality of life in all patients;
• Full oral diet for all patients;
• Discontinuation of regular pain medication in most patients.
  *Patients remain on varying amounts of insulin.

The team has coordinated surgical and medical care to maintain euglycemia as the patients鈥� diet advanced, as well as to identify new psychosocial issues following stress of surgery. Care coordination and social worker check-ins also aid in patents鈥� ease of access and identification of any barriers to follow-up.

鈥淥ur TPIAT team is an excellent example of expert multidisciplinary care for a very challenging patient population,鈥� said Peter A. Banks, MD, Director of the Center for Pancreatic Disease.
鈥淲e continue to research new ways to enhance our patients鈥� results.鈥�

• Thomas Clancy, MD
  Associate Director for Pancreatic Cancer,
  Division of Surgical Oncology
• Peter A. Banks, MD
  Director, Center for Pancreatic Disease