Pancreatectomy with Islet Cell Autotransplantation (TP-IAT)

Total pancreatectomy with autologous islet cell transplantation - also more simply referred to as pancreatectomy with islet cell autotransplantation (TP-IAT) – is a treatment option for patients whose chronic pancreatitis has not responded to conventional treatment. In this procedure, the diseased pancreas is removed but islet cell clusters from the pancreas are preserved and placed in the patient’s liver so the body can maintain insulin production and blood sugar levels. This treatment provides our patients relief from chronic pancreatitis without the side effects of a donor organ (through pancreatic transplant) and with a much lower risk of developing brittle diabetes from the loss of the pancreas (through pancreatectomy without islet cell preservation).

Chronic pancreatitis is a severe and very painful condition with a significant impact on quality of life. Often patients rely on narcotic pain medications to manage day-to-day living which impedes with their ability to work and drive. Removing the pancreas is the best treatment for chronic pancreatitis, but in doing so, the patient’s ability to create insulin is also removed, putting them at risk for a severe form of diabetes and its resulting complications. By preserving insulin production through islet cell autotransplant, the chances of developing brittle diabetes as a result are greatly reduced.

The pancreas can be a very wicked organ. I am thankful and blessed there are Dr. Levys in the world that are on such a high level that they can do this miraculous surgery and make people better. I will forever be grateful. - Jolie Dunham, patient

 

Hume-Lee’s islet cell autotransplantation program was developed by Dr. Marlon Levy, one of the leading experts in the treatment of refractory chronic pancreatitis in the nation. Dr. Levy served as the former chair of the division of transplant surgery at VCU, and is currently the Interim CEO of the VCU Health System.

Dr. Aamir Khan joined the TP-IAT team in 2017, and currently serves as the Medical Director of Islet Cell Transplant Program. The Hume-Lee team has a high level of expertise with this procedure, with the majority of patients reporting a dramatic decrease in pain and pain mediation reliance and a large majority with good blood-sugar control following the procedure. In February 2024, the TP-IAT team successfully completed their 100th TP-IAT procedure.

The Hume-Lee Transplant Center’s dedicated islet cell transplant laboratory is led by Mazhar Kanak, PhD and VCU assistant professor of surgery. Dr. Kanak is an accomplished researcher in the field of inflammatory events of islet engraftment, both allogeneic (donor islet cells) and autologous (patient’s own islet cells). VCU has been an active member of the Collaborative Islet Transplant Registry (CITR) since its establishment in 2016. In 2023, this state-of-the-art facility was awarded a contract to be an Islet Isolation Center (IIC) for the Integrated Islet Distribution Program (IIDP). Before VCU, only 5 other centers in the United States have received the status of an IIC from the IIDP. The IICs are qualified based on the expertise of the isolation team and center director credentials, working relationships with local as well as specific distant Organ Procurement Organizations with the provision of consistent access to quality donor pancreata, exemplary islet isolation history, and stable recipient satisfaction.

This specialized team of pancreatic disease and islet transplantation experts is joined by gastroenterologists, interventional radiologists, nurse coordinators, internal medicine specialists and dieticians who all work to provide immediate and long-term care to give each of our patients the confidence that they are receiving the best possible standard of care for their specific needs.

The VCU Hume-Lee Transplant Center is the only medical center in the Richmond metropolitan area offering this innovative procedure, and the only center in the mid-Atlantic region with the level of expertise that gives patients the best chances for a successful outcome.

For six years, I was having pain and trouble eating. Dr. Levy understood and wanted to help me get a better quality of life. After having the pancreatectomy with islet cell autotransplant, not only am I pain-free but I am now a mother working towards my goals. - Ashlyn B., patient

 

Left to right: Yoshiko Tamura, M.S.; Lyndy Johnson, MSN; Elijah Burch, M.S.; David Bruno, M.D., FACS; Aamir Khan, M.D.; Marlon Levy, M.D.; Mazar Kanak, Ph.D.; Allison Lewis, MSN, R.N.; Prathab Balaji Saravanan, Ph.D.; Kate Best, MHA. 

How It Works

During this procedure, the patient’s pancreas is completely removed by a transplant surgeon and islet cell clusters from the pancreas are extracted and purified in Hume-Lee’s islet cell laboratory. The cleaned islet cells are then infused into the patient’s own liver through the portal vein, where they will eventually begin to produce insulin. The patient will remain under sedation during the entire process, which typically takes around 10 hours.

Following the surgery, our patients typically stay in the hospital for 8-10 days. During this time, the patient will receive insulin infusions to allow the liver and islet cells time to rest to ensure complete and successful islet cell engraftment.

After discharge and over the course of the next several months our patients are closely followed by a surgeon and nurse coordinator, who will monitor the liver’s ability to produce insulin. Once sustainable insulin production is confirmed, the liver has then effectively taken on the job of the pancreas. Post-surgery, most patients are able to function with little or no dependence on insulin injections.

Total pancreatectomy with islet cell autotransplantation offers dramatic improvement in quality of life and freedom from debilitating pain, while preserving good blood-sugar control. It’s a breakthrough in the treatment of an otherwise very painful, intractable disease.

- Marlon F. Levy, MD, FACS

Goals and Benefits

The goal of pancreatic removal with islet cell autotransplant is to improve the patient’s quality of life through the removal of the infected pancreas, while still maintaining the body’s ability to control blood sugar. The benefits include a decrease in pain and dependence on pain medications, the avoidance of having to wait on an organ donation waiting list and the elimination of the risk of the body’s rejection of donor tissue.

Candidate Evaluation

Ideal candidates for TP-IAT have attempted and not responded to traditional treatments for chronic pancreatitis, and are enduring a poor quality of life with no other medical contraindications. Patients are typically referred to the Hume-Lee Transplant Center by their gastroenterologist or pancreatologist, and are then reviewed by our islet cell specialists to make sure the benefits of the procedure outweigh any risks.

Our multi-disciplinary team works closely with referring providers to determine and monitor the best course of treatment for each patient. Our ultimate goal is to return patients back to their referring provider for follow-up care in a state of good health and with a renewed ability to live a full life. To refer yourself or a patient to our pancreatectomy with islet cell autotransplantation program, please call (804) 828-6705.

Pancreatitis Review Committee 

Our Pancreatitis Review Committee is a dedicated team of experts from four key specialties: Transplant Surgery, Gastroenterology/Endoscopy, Pediatric Gastroenterology, and Adult and Pediatric Radiology. This diverse group of medical professionals meets on a  monthly basis to review and discuss cases of adult and pediatric patients experiencing pancreatic issues, such as pseudocysts, pancreatitis, and exocrine pancreatic insufficiency (EPI), and other diseases as needed.

The committee's multidisciplinary approach ensures a comprehensive evaluation of each patient, allowing for the development of personalized care plans that address the unique needs of each individual. By leveraging the collective expertise of specialists across different fields, the committee facilitates quicker access to a wide range of holistic providers and advanced treatment options.

This collaborative approach not only streamlines the decision-making process but also enhances the quality of care, offering patients the most effective and up-to-date treatment strategies available. Through our committee, we are committed to delivering the best possible outcomes for our patients, ensuring they receive the comprehensive and coordinated care they need.

National Recognition

We are recognized by the National Pancreas Foundation as an approved NPF Center - one of a handful in the Southeast and one of two in Virginia. According to the NPF, these centers are at premier health care facilities that focus on multidisciplinary treatment of pancreas disease, treating the whole patient with a focus on the best possible outcomes and improved quality of life.