Favorable Long Term Outcomes with Total Pancreatectomy and Islet Transplantation

One of the top surgical options for those suffering from chronic pancreatitis is removal of the pancreas, with transplantation of the pancreas’s islet cells to the liver.  (The surgery is called total pancreatectomy with islet autotransplantation, commonly abbreviated TP/IAT.)

When successful, this removes the source of pain and toxicity — the exocrine function of the pancreas, or its production of enzymes — while allowing the liver to perform the endocrine function of the liver (the production of insulin).  Patients must take enzymes for food disgestion, but if sufficient healthy islet cells are left and the transplantation succeeds, patients would not become diabetic and require insulin.

Many patients report that the surgery is a lifesaver, greatly reducing their pain and allowing them to live a normal life again. Recently we posted a video that discusses outcomes 6 and 12 months after surgery, finding a significant increase in physical and mental health ratings and improvement in quality of life.

In October, a study will be published in the Annals of Surgery examining patient outcomes five years after TP/IAT surgery for 112 patients.  There were no deaths at the time of surgery and the survival rate after five years was almost 95%.   There were continued improvements in reported quality of life during the period, and at five years 73% were “narcotic independent.”  Only 27% ended up insulin independent at the end of the period.

Bear in mind that the procedure is relatively new, and is constantly evolving.  For example, the surgery has just started being performed laparoscopically, which should be expected to improve outcomes. It is fair to assume that the more recent procedures are even more favorable statistically than ones performed ten years ago.  On the other hand, there is no truly longitudinal data that indicate how patients fare without a pancreas decades after the procedure, something patients are very keen to understand.

You can find an abstract of the article here.