Total pancreatectomy and auto islet transplantation, which utilizes a patient’s own islet cells, is a specialized treatment for patients suffering from chronic pancreatitis. It may also be an appropriate option for other pancreas diseases as well.

The procedure involves removing the pancreas, procuring from the pancreas the islet cells, which produce insulin and other hormones, and then implanting them into the liver, which adapts to host the islet cells. Because the patient’s own islets are used, there is no risk of rejection and no need for immunosuppression drugs.

With the diseased pancreas removed, at a minimum, most patients enjoy a significant reduction or complete elimination of pain, which ultimately means they can also decrease or eliminate their reliance on pain medications, thus other chronic digestion problems may alsocome to an end. Of course, with the successful islet cell transplant, diabetes can be prevented or halted from further development. In the case that the islet cells don’t thrive after transplantation, the other benefits of the procedure – pain reduction and improved digestion – remain.

How Ohio State eliminates pain of pancreatitis with Auto Islet transplantation.

Why choose Ohio State?

The Comprehensive Transplant Center at The Ohio State University Wexner Medical Center is one of the largest organ transplant programs in the nation. Over 9,000 organ transplantations have been performed here since 1967.

Experience:
  • The only institution in central Ohio, and one of a small number in the nation, with an FDA-approved isolation laboratory for pancreatic auto islet transplantation, which ensures that the process is done to the highest standards.
  • A National Pancreas Foundation Center for pancreatitis and pancreatic cancer since 2014. This designation recognizes premier healthcare facilities that focus on multidisciplinary treatment of the “whole” patient to enhance the best possible outcomes, improve quality of life and advance research.
  • Active member of the Collaborative Islet Transplant Registry (CITR) since 2008. Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, the mission of CITR is to expedite progress and promote safety in islet cell transplantation.

Commitment: Our multidisciplinary team works together to optimize patient outcomes. This includes gastroenterologists, transplant surgeons, endocrinologists, transplant psychologists, social workers and an extensive support team, each addressing individual factors that impact transplantation success. Always interested in the next breakthrough, our disease specialists also participate in clinical trials for pancreas disease and islet transplantation outcomes that are sponsored by the National Institute of Health.

Proven Success: Ohio State performed its first auto islet transplant in 2008, so we’ve gained the important insight and experience needed to successfully prepare, treat and support our patients before, during and after the surgery.

 

Candidates

Candidates

Candidates

  • Patients suffering from chronic pancreatitis and the incapacitating pain it can cause may benefit from auto islet transplantation, particularly when other treatment options, such as medical, endoscopic and other surgical interventions, have failed to provide relief and there is significant risk of developing diabetes with more interventions.
  • If identified as appropriate by your gastroenterologist, islet auto transplantation may also be a viable treatment option for some other pancreatic conditions. People with metastatic cancer, active infection or severe medical problems are generally not candidates for the procedure.
  • All patients must meet the chemical dependency requirements of the Ohio Solid Organ Transplantation Consortium. The use of tobacco, alcohol and illicit drugs is carefully examined.
  • Patients who meet criteria for alcohol or drug dependence must undergo at least three months of rehabilitation and demonstrate three months of abstinence before transplantation. Patients with chronic conditions such as high blood pressure may need to stabilize their conditions before transplantation, and we will work across medical disciplines to support these improvements.

Patient Process

Patient Process

Patient Process

Because total pancreatectomy and auto islet transplantation involves removal of the pancreas, it is not considered a first line of treatment. However, it can prove extremely effective for selective candidates who can be identified through an extensive evaluation prior to transplant. To improve outcomes, Ohio State supports patient education and engagement before, during and after auto islet transplantation.

Referral Phase

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.

Clinic Evaluation Phase

Our goal is to have the pre-transplant screening completed during a single outpatient visit. This includes testing, lab work, education, social work consultation and surgeon interview.
  • 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.

Transplant Phase

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.

Post Transplant Phase

  • 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.

Treatment Team

Treatment team

Treatment team

Our Comprehensive Transplant Center treatment team includes:


Gastroenterologist

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.

Islet Transplant Surgeon

This doctor uses highly specialized equipment in the islet isolation lab to extract the islet cells from your removed pancreas, then transplant them back into your liver to help your body produce insulin.

Pancreas Surgeon

This doctor will perform the surgical procedure to remove the pancreas; reestablish connections required following pancreas removal. Your surgical team will discuss the risks and benefits related to surgery and assist you in understanding what to expect after receiving your transplant.

Transplant Endocrinologist

This doctor specializes in balancing the hormones, enzymes and other pancreatic functions and follows patients before, during and after transplant. He or she will complete a physical exam and discuss testing that is needed prior to the surgery and will monitor recovery and insulin levels following.

Transplant Coordinator

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.

Islet transplant coordinator:

  • Jill Buss - Lab Services Coordinator

Pre-transplant coordinator:

  • Teri Davis, MSN, RN

Post-transplant coordinator:

  • Karen Luciano, MBS, BSN, RN, CCTC

Pain Management Specialist

Many patients with chronic pancreatitis have become dependent on significant amounts of pain medication. This specialist helps patients gradually decrease their dependence while minimizing withdrawal symptoms.

Nutritionist

This healthcare specialist provides diet guidelines and nutrition education to support proper blood sugar levels and long-term health. He or she works to identify foods that are not only healthy, but that the patient enjoys eating so that long-term healthy eating habits can be established.

Social Worker and Psychologist

These professionals meet with you to evaluate your psychological readiness for transplantation.
  • Kristin Kuntz, PhD
  • Kim Ansley, MSW, LSW
  • Megan Momsy, LISW-S
  • Beca Pruzan, MSW, LSW 
  • Melissa Skillman, LISW-S

Pharmacy Patient Coordinator

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.
  • Emily Snow, 800-626-2538
  • David Williams

Frequently Asked Questions

What results can be expected with a pancreatectomy and auto islet transplant?

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.

How soon will I know if my islets survived the transplant and are producing insulin?

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.

How long does the actual surgery take?

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.

How can islets survive in the liver?

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.

When can I be considered for auto islet transplantation?

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.

Will I be “cured” after transplantation?

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.

If my pancreas is removed, why could some level of pain remain?

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.

I’ve been on pain medications so long, how can I ever expect to get off of them?

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.

This is a “transplant,” so do I need immune suppression drugs?

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.

Do I have to change what I eat after an auto islet transplant?

We suggest you continue following the healthy eating habits you worked to identify with your nutritionist before transplantation to control blood sugar and improve overall health, but there are not blanket diet restrictions following transplant. Many patients have dramatically improved digestion after transplant and a new-found enjoyment with eating.

 

Tips From Our Experts

Acute Pancreatitis: Causes, Diagnosis and Care at Ohio State

Acute pancreatitis can cause incredibly severe pain. Luis Lara, MD, Medical Director for Ohio State's Total Pancreatectomy and Islet Transplantation program, explains the causes, diagnosis and treatment of the condition.

Auto Islet Transplantation and Other Treatment Options

Auto Islet transplantation and other treatment options for chronic pancreatitis, explained by Luis Lara, MD, Medical Director for Ohio State's Total Pancreatectomy and Islet Transplantation program.

Pancreatic Auto Islet Transplant Surgery at Ohio State

Amer Rajab, MD, PhD explains the surgery process for a total pancreatectomy and auto islet transplant for patients suffering from chronic pancreatitis.

Our Doctors

Share this Page