Pancreatic Auto Islet Transplant

Referral for auto islet transplantation often comes from your gastroenterologist. Other physicians, dialysis centers, insurance case managers and other transplant centers may all request a referral.

Pre-transplant referral steps include:

1. The referring party is responsible for providing the transplant coordinator with all applicable medical information according to the transplant referral protocol provided at time of referral.
2. You will need to notify your insurance company before making your initial evaluation appointment. Our pre-transplant office and hospital business office will work with you to determine insurance availability and precertification requirements.
3. Pre-transplant coordinators and business office staff then work together to meet insurance company requirements for evaluation and transplant procedure approval.

• The comprehensive education program details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process.
• A social worker evaluates each transplant candidate to ensure sufficient psychological stability, motivation and personal support to meet the challenges of transplantation. A psychosocial survey completed before the appointment will be reviewed in person.
• If additional information is required, this will be included in a follow-up letter to your referring physician.
• Additional referrals could be requested for cardiology, pulmonary, infectious disease or other services as warranted.
• A transplant team comprised of different medical specialists will evaluate the patient’s information and determine whether transplantation is appropriate.
• A letter and a copy of the pre-transplant patient chart are sent to your insurance company, requesting precertification of the transplant procedure.
• Following approval, we will begin scheduling the next treatment steps.

While we prefer all testing be completed at Ohio State University, if your geographic location or payer preference makes this difficult, we will work to coordinate testing elsewhere.

Because the patient does not require a donor, there is not a “wait list” with auto islet transplantation. Following the scheduled surgical procedure, patients may remain in the hospital for 5-10 days depending on their health and time required for sufficient recovery.

Auto islet transplantation requires some specific patient education:

• Once the pancreas is removed, the patient is immediately considered a “surgical diabetic.” To prepare for this sudden loss of all insulin, the patient must be trained in advance to monitor their own glucose i levels and understand proper blood sugar maintenance.
  • For every patient, controlling glucose is mandatory while waiting to see if the transplanted islets begin producing sufficient insulin on their own a few days after transplantation.
  • For those patients whose islets ultimately don’t produce enough insulin or do not survive, diabetes management will be a lifelong skill.
• A nutritionist will also work with transplantation patients to support proper blood sugar control through diet.

• Within several days, surviving islets will begin producing insulin. However, continual blood sugar monitoring remains important until adequate independent insulin levels are maintained.
• There are no physical or extreme dietary restrictions following discharge from the hospital. Nevertheless, patients should stick to the diet recommendations made with the nutritionist to improve their overall health, increase the odds of islet survival and control blood sugar.
• Because they no longer have their pancreas to produce important enzymes for digestion, all auto islet transplant patients will require supplemental enzymes the rest of their lives.
• If your islets do not produce enough insulin or fail to survive transplantation, long-term diabetes management will be necessary. Even when this is the case, patients report extreme satisfaction with the total pancreacetomy and auto islet transplantation because their pain and digestive issues have been resolved or tremendously improved. In fact, improvement of quality of life is reported by over 90 percent of patients who have had this procedure.
• Removal of the pancreas nearly always eliminates or significantly reduces the need for pain medication. To support the gradual reduction of pain medication and minimize withdrawal symptoms, patients may work with a pain management specialist.
• Patients will have a follow up appointment approximately a week after they are discharged from the hospital. Care will then transition to every few weeks with an endocrinologist and gastroenterologist. This will then extend to every month or longer until the first-year anniversary of transplantation, after which appointments will then only occur annually or as needed.
• Full recovery typically takes 6-8 weeks, and patients are expected to return to work and resume regular activities. With their pain resolved, many find they are able to do even more than they could before the surgery and their quality of life improves tremendously.

This doctor specializes in pancreatic conditions and diseases and the impact on overall digestion and health. This specialist will provide the long-term follow up required after transplantation.

These are nurses who will be your primary contact from the time you are referred for a transplant evaluation throughout your care at Ohio State. They will help answer any questions you may have and assist you throughout your transplant experience.

The pharmacy patient coordinator offers assessment, linkage and referrals for assistance to patients who need certain medications and have high co-pays or no prescription drug coverage.

Contact: 800-626-2538

Results vary by patient and are impacted by current pancreatic function as well as overall health.

• Over 90 percent of auto islet transplant patients report being extremely satisfied with the procedure and the improved quality of life that they enjoy. This is primarily due to the resulting reduction in pain caused by chronic pancreatitis, the decrease or elimination in required pain medications and improved digestion.
• Approximately 2/3 of all patients undergoing an auto islet transplant have some level of insulin production, which ultimately eliminates or reduces their dependence on insulin.
• Approximately 1/3 of auto islet transplant patients do not produce insulin and remain with surgically-induced diabetes. However, even with these statistics, patients have a much improved quality of life and reduction of pain.

Although you will be a “surgical diabetic” immediately following the surgery, and will thus require insulin injections, we will know if the islets have begun producing insulin from their new location in the liver within a few weeks following surgery. Your endocrinologist will continue to monitor insulin levels and help you adjust your blood sugar management until your “new normal” is established and we know how much insulin you are or are not able to produce on your own.

The entire process can last up to 12-14 hours. In the first part of the surgery, your damaged pancreas is removed and the islets are extracted in a sterile lab. While the extraction is occurring, a second surgeon is repairing the areas once connected to the pancreas. Your abdomen is then partially closed and you are monitored for complications while the islet extraction is completed. Once viable islets are obtained, they will be placed into the portal vein in your liver. Following surgery, patients can expect to remain in the hospital 5-10 days.

While some inflammation may occur in the liver immediately following islet transplantation, it does not compromise long term liver function and the islets can continue producing insulin despite their new location – they are not dependent on the pancreas for survival, simply for a place to exist, and the liver serves as anacceptable substitute. Had they been left in a diseased pancreas, the islets would eventually be “choked” by fibrotic pancreas tissue and die. This is why it important to properly schedule an auto islet transplant before the pancreas becomes too damaged.

We prefer you don’t wait until your pancreas has been severely damaged by inflammation or your islet function impaired by calcification. We encourage physicians to refer those who suffer from chronic pancreatitis or other pancreas disorders for evaluation so that we can identify the appropriate and ideal time window for transplantation. Because you don’t need to have a donor for this procedure, it is easier to schedule the surgery at a time that is ideal for your particular situation.

Your pain will usually improve and may go away all together. However, you will always require supplemental pancreas enzymes after an auto islet transplant to support proper food digestion and may also require lifelong insulin injections if the islets don’t survive in the liver. Nevertheless, well over 90 percent of patients report extreme satisfaction following the procedure, due in large part to their pain reduction and improvement in quality of life.

Following years of pain, the brain is conditioned as a pain receptor. Although most patients enjoy complete relief from pain following pancreas removal, some patients may still have some residual “phantom pain” as nerve fibers continue to fire. Even in these instances, most patients still find that they can reduce their use of pain medications over time. Overall, 75 percent of auto islet transplant patients report a significant decrease or complete elimination of pain meds.

Most patients with chronic pancreatitis have developed high levels of tolerance to pain medications and are therefore using very high dosages when they first come to Ohio State University. We understand the importance of stepping down dosages over time and our experienced pain medication managers work with patients to minimize side effects and reduce reliance on these medications over the course of several months.

Because you are not relying on an outside donor and your own islets are simply being moved from your diseased pancreas to your healthy liver, there is no risk of rejection and no long term immune suppression drugs are required.