(from lt to rt): Jack Cook, Kenneth Brayman, Preeti Chhabra, and Mingyang Ma
Auto Islet Transplantation (AIT), performed in conjunction with a total pancreatectomy (pancreas removal), offers a cutting-edge solution for chronic pancreatitis while minimizing the risk of surgically induced diabetes. The University of Virginia’s AIT program, directed by Kenneth Brayman, MD, PhD, is one of only a few programs of its kind in the United States, making UVA a leader in advanced pancreatic disease management.
Pancreatitis and Diabetes
In the pancreas, specialized groups of cells called islets maintain a healthy blood sugar level by producing glucose-regulating hormones. Alpha cells produce glucagon to increase blood sugar, while beta cells produce insulin to reduce blood sugar as needed. Chronic pancreatitis can be caused by a number of issues, including congenital anomalies, cancer, gallstones, autoimmune disorders, genetic conditions, and alcohol use. The condition is associated with severe abdominal pain that often leaves patients reliant on or addicted to pain medication.
When other treatments have failed, a total pancreatectomy can be an effective option to relieve pain. However, removing the pancreas causes diabetes by eliminating the body’s source of glucose-regulating hormones. These patients must intensively monitor their blood sugar and administer regular insulin injections. Many develop brittle diabetes, a severe and difficult-to-manage form of diabetes where glucose levels swing rapidly between high and low extremes. These patients are also at an increased risk of developing hypoglycemic unawareness, a condition where a patient does not feel the physical symptoms of a severe hypoglycemic episode before its onset. This condition is extremely dangerous because patients may lose consciousness without warning while performing daily activities.
How TPAIT Can Help
TPAIT offers a definitive solution to this problem by preserving islet cell function, thereby preventing postoperative diabetes or mitigating its severity if it does develop. During a TPAIT procedure, the patient’s pancreas is removed and sent to a laboratory where the islet cells are isolated, processed, and ultimately infused back into the patient, usually into the liver.
Once the cells have been transplanted, they continue to produce glucose-regulating hormones, effectively replacing the endocrine function of the pancreas. The procedure has a very high success rate, with up to 80-90% of patients experiencing a significant reduction in pain that allows them to stop or reduce their use of pain medication. This is a monumental step forward for patients struggling with addiction. A patient’s postoperative reliance on insulin is dependent on several factors, but in some cases, patients do not require any insulin administration following the procedure.
Ongoing Efforts
Research is ongoing to better understand islet cell function and to increase the success rate of the procedure. Strategies include increasing transplant success by promoting cell engraftment and increasing the long-term durability of islet grafts. Learn more about this research here.
The University of Virginia is one of about 12 programs in the United States that focuses on managing advanced pancreatic disease in this way to control pain, preserve islet function, and avoid diabetes. UVA conducted its first islet transplant in 2005 and its first TPAIT procedure in 2007. UVA has completed about 60 of these cases since then.
TPAIT is a highly technical procedure that requires significant infrastructure, including an FDA-approved GMP facility to process tissues and specialized expertise on the part of laboratory technicians. Dr. Brayman emphasized that UVA’s multidisciplinary team approach plays a large role in the TPAIT program’s success. Patients are often referred to Surgery by Gastroenterology and receive ongoing support from Endocrinology, so they are carefully monitored by UVA physicians during every stage of their care.
Article by Holly Atkinson. Contributed photo.
Filed Under: Clinical