Chronic pancreatitis can lead to debilitating, life-limiting pain. That pain routinely stopped David Wright in his tracks.
“I would literally double over and couldn’t move,” he said.
Medication would sometimes reduce the attacks. Pain blocks administered by an advanced endoscopist at Baylor University Medical Center worked for a while, too. But the chronic pancreatitis pain would hit unexpectedly and with such a force that the West Texas eye doctor finally decided to pursue an islet cell transplant.
He was the 200th islet autotransplant patient at Baylor University Medical Center, the only transplant center in Texas and one of the largest programs in the world providing this kind of relief for people with chronic pancreatitis.
Relief for chronic pancreatitis pain
After exhausting other medical and surgical options, many people opt for surgery to remove their pancreas. But without a pancreas to regulate blood sugar, patients face a life of diabetes and insulin injections.
The solution? Total Pancreatectomy with Islet Auto Transplant (TP-IAT).
During the unique and complex surgery, the pancreas is removed to eliminate the source of the pain. Immediately after surgery, the entire pancreas is taken to the lab to isolate the islets, the cells that produce insulin. These processed cells are then returned to the operating room and infused into the patient’s liver. Those islet cells slowly wake up and begin producing insulin in their new home. Because the body accepts these islet cells as its own, there is no rejection and no need for immunosuppressive medications.
For David, the surgery was life-changing.
“The alternative was literally spending days in bed,” he said. “I had to step back from my practice. I couldn’t think about travel or playing with my grandchildren. My life came to a standstill.”
“That’s exactly what happens,” said Ernest Beecherl, MD, medical director of the islet autotransplant program at Baylor University Medical Center. “Because this is such a complex operation, you don’t want to do the surgery if the condition can be medically managed. But you also don’t want patients wasting away and becoming too dependent on narcotics as they try to dull their excruciating pain.”
With chronic pancreatitis, the pancreas is inflamed, leading to permanent damage. A damaged pancreas doesn’t produce important digestive enzymes, so people living with chronic pancreatitis often have problems digesting and absorbing food and nutrients. This leads to weight loss, vitamin deficiencies and diarrhea. Over time, the damaged pancreas may stop producing enough insulin, which results in diabetes.
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Life-changing Islet Autotransplant
By mid 2020, David Wright was done with his “useless” pancreas — as proclaimed by a t-shirt gifted him by his daughter.
Only a handful of other transplant centers in the U.S. have performed a comparable volume of islet autotransplants for chronic pancreatitis.
“This procedure is rare and it’s difficult to perform,” said Bashoo Naziruddin, PhD, director of the islet cell laboratory at Baylor University Medical Center. “Not many centers offer it. However, our dedicated group of islet specialists have elevated our ability to isolate a high volume of quality islet cells. As a result, the number of procedures we perform annually has grown and our outcomes are good.”
Surgeons on staff at Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Center performed the first total pancreatectomy with islet autotransplantation in Texas in 2006. Now, between 10 and 20 islet autotransplants are performed every year. One third of patients are insulin-free at the one-year mark, a third of them need to supplement their islet function with a little bit of long-acting insulin on a daily basis, and the other third are similar to a type 2 diabetic, meaning they take long-acting insulin and check their blood sugar levels four times a day.
Dr. Wright returned home to west Texas about a month after his surgery. During his three-month checkup, he told Dr. Beecherl that his pain is now gone. He looks forward to returning to his ophthalmology practice and patients, and getting back to his life pain-free.
“I’d definitely go through it all again,” he said.
Typically, patients who undergo total pancreatectomy need large doses of insulin for the rest of their life. However, thanks to the islet autotransplant option at Baylor University Medical Center and a good yield of islet cells from Wright’s diseased pancreas, he should have a mild, easily managed life with diabetes — or perhaps the islet cells will function so well he won’t have to take any insulin at all.
Are you or a loved one living with debilitating pain from chronic pancreatitis? Find out if you are eligible for an islet autotransplant.
About the author
Linda Huante is a senior physician liaison for abdominal transplant and liver disease at Baylor Scott & White Health.