Cincinnati Children's Performs Its First Transplant Procedure Involving Removal of Pancreas to Stop Debilitating Pain

Tuesday, July 07, 2015

The Pancreas Care Center at Cincinnati Children’s has performed its first total pancreatectomy with islet auto-transplantation (TP-IAT) on a 12-year-old girl from eastern Kentucky with pancreatitis.

With a TP-IAT, surgeons remove a patient’s entire pancreas to stop the debilitating pain caused by severe inflammation. The patient’s own insulin-producing islet cells are then isolated at the Hoxworth Blood Center, returned to Cincinnati Children’s, and transferred via the portal vein to the patient’s liver. It’s hoped that they engraft in the liver and begin to secrete insulin.

“Our main goal in doing a TP-IAT is to resolve what is often excruciating pain, thereby improving a patient’s and family’s quality of life,” says Jaimie Nathan, MD, surgical director of the Pancreas Care Center. “Our hope over the coming months is that the islet cells ‘take’ and begin producing insulin, thereby reducing the risk of diabetes. This happens in about one-third of patients.”

Mallory Crum, from East McDowell, KY, had her first attack of pancreatitis in October 2013. Despite numerous procedures to alleviate the pain, her condition became chronic, and doctors were not been able to determine the cause. She also has autism, diagnosed at the age of 18 months. She was a 12-year-old girl “with basically no life,” according to Mallory’s mom, Debbie Crum.

“She was unable to continue her school work, play outside, go on vacation, swing, jump on the trampoline, do all the things she loves to do,” says Debbie. “We couldn’t ever go out as a family due to the pain. It seems we were in the hospital every two weeks. Our daily lives were put on hold for this disease.”

Cincinnati Children’s opened its Pancreas Care Center in 2013 to provide specialized care for children with pancreatic diseases, including rapid diagnosis, effective therapies and pain management.

A multidisciplinary care team makes the center unique. The team is led by pediatric gastroenterologists and includes physicians specializing in pain management, endocrinology, and radiology. They work closely with the center’s genetics counselor, pain psychologist, nurses, registered dietitian and social workers to address all aspects of a patient’s condition.

An important focus of the pancreas team is to standardize patient care protocols with the goal of minimizing exposure to narcotics, shortening hospital stays and improving clinical outcomes.

The team is also actively involved in research to better understand the underlying causes of pediatric pancreatic disorders.

“Pediatric pancreatitis was once thought to be uncommon, but from recent studies we know now that it has an incidence of 13 per 100,000, close to adult pancreatitis,” says Maisam Abu-El-Haija, MD, clinical director of the Pancreas Care Center. “It is very important to recognize that it is a different illness than adult pancreatitis and that specialized therapy needs to be applied to pediatric patients.”

Dr. Abu-El-Haija is the principal investigator of the Center’s patient registry, which will help researchers and clinicians understand the natural history of the disease and provide information that potentially can lead to effective therapies for pancreatitis.

When surgeons removed Mallory Crum’s pancreas, they discovered it was in worse shape than they expected. “It was like a rock,” according to Dr. Nathan, and it had adhered to other internal structures, making removal difficult. Once they did remove it, they had to reconstruct the bile duct and other portions of the gastrointestinal tract. Like all patients who undergo this procedure, Mallory will have to take pancreatic enzyme replacement therapy for the rest of her life. These are digestive enzymes that are taken orally to break down fats, proteins and carbohydrates.

Mallory will need insulin injections for at least six months to replace the insulin her pancreas previously produced. It is hoped that, once her liver makes sufficient insulin, she can be weaned off the insulin. Approximately 40 percent of patients are off insulin after one year. Thirty percent have only partial islet formation and need basal insulin, a longer-acting background dose. Another 30 percent are insulin-dependent.

“Everyone at Cincinnati Children’s involved in this procedure has become a part of our extended family,” says Debbie Crum. “Mallory is a different child already. She has a smile on her face and not a look of pain and misery.”

The first TP-IAT procedure took place in 1977 at the University of Minnesota Medical Center, which has now treated more than 400 patients with chronic pancreatitis using TP-IAT. The University of Cincinnati also offers TP-IAT, but only in teens and adults. Very few other centers offer the procedure in people of any age.

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News & World Report’s 2015 Best Children’s Hospitals. It is also ranked in the top 10 for all 10 pediatric specialties. Cincinnati Children’s, a non-profit organization, is one of the top three recipients of pediatric research grants from the National Institutes of Health, and a research and teaching affiliate of the University of Cincinnati College of Medicine. The medical center is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org. Connect on the Cincinnati Children’s blog, via Facebook and on Twitter.