# Islet Cell / TPIAT — GCMD Library living collection

Also covered as: acute recurrent pancreatitis · chronic pancreatitis

Experts: Dr. Jamie Nathan, Dr. Joe Palermo, Dr. Deb Elder, Dr. Ken Goldschneider

Updated: n/a · 3 episodes · 67 cited statements

## Episodes
### Fundamentals
- [Welcome and Introductions: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969) — video · 6:04 · [machine version](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969.md)

### Surgical Management
- [Total Pancreatectomy with Islet Autotransplantation: Pancreatic Disease](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973) — video · 47:20 · [machine version](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973.md)
- [Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540) — video · 10:19 · [machine version](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=0) Welcome, Housekeeping, and Event Introduction (Ep 1)
- [3:33](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=213) Course Director Introduction and Faculty Panel Presentation (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=0) Introduction and Overview of TPIAT Session (Ep 2)
- [1:30](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=90) Case Presentation: 13-Year-Old with Chronic Pancreatitis (Ep 2)
- [4:44](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=284) TPIAT Indications and Multidisciplinary Evaluation (Ep 2)
- [8:30](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=510) Endocrinology Assessment and Glucose Tolerance Testing (Ep 2)
- [13:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=794) Preoperative Pain Management Approach (Ep 2)
- [18:17](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1097) Surgical Evaluation and TPIAT Criteria (Ep 2)
- [25:49](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1549) Perioperative Pain Management Protocol (Ep 2)
- [26:44](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1604) Surgical Technique and Islet Isolation (Ep 2)
- [34:47](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2087) ICU Management and Early Postoperative Care (Ep 2)
- [39:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2354) Pain Management Outcomes and Weaning Strategy (Ep 2)
- [42:03](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2523) Glucose Management Protocols (Ep 2)
- [43:49](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2629) Summary and Closing Remarks (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=0) Introduction and patient selection criteria for TPIAT (Ep 3)
- [2:01](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=121) Surgical procedure and technique (Ep 3)
- [4:25](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=265) Islet isolation and reinfusion process (Ep 3)
- [7:36](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=456) Post-operative care and recovery (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Cincinnati Children's has been leading the world in pediatric surgical education" — Todd Ponsky (opinion) [Ep 1 · 0:28](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=28)
- "The event will be recorded and available after 48 hours" — Todd Ponsky (clinical) [Ep 1 · 1:22](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=82)
- "A new video portal will allow users to search by keyword and watch specific segments rather than entire events" — Todd Ponsky (clinical) [Ep 1 · 1:27](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=87)
- "The Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world" — Todd Ponsky (clinical) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=120)
- "Cincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists" — Todd Ponsky (clinical) [Ep 1 · 2:38](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=158)
- "Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's" — Todd Ponsky (host_summary) [Ep 1 · 3:06](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=186)
- "The day's sessions will cover surgical approaches, interventional endoscopic approaches, and medical management of acute, acute recurrent, and chronic pancreatitis" — Jamie Nathan (clinical) [Ep 1 · 3:38](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=218)
- "Dr. Joe Palermo is a pediatric gastroenterologist and medical lead of the total pancreatectomy and islet auto transplantation program" — Jamie Nathan (clinical) [Ep 1 · 4:05](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=245)
- "Ken Goldschneider is director of pain management at Cincinnati Children's, professor of clinical pediatrics and anesthesia, and plays a central role in pain management for patients with pancreatic diseases" — Jamie Nathan (clinical) [Ep 1 · 4:23](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=263)
- "Dr. Maisam Abu El-Haija is a gastroenterologist, co-director of the course, and medical director of the Pancreas Care Center" — Jamie Nathan (clinical) [Ep 1 · 4:40](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=280)
- "Tom Lynn is a gastroenterologist who manages the vast majority or all endoscopic needs for children with pancreatic disorders, director of endoscopy for the Pancreas Care Center, and co-director of endoscopy for the division of gastroenterology" — Jamie Nathan (clinical) [Ep 1 · 4:54](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=294)
- "Andrew Trout is the lead radiologist for the Pancreas Care Center, assistant professor of radiology, and dual certified in pediatric radiology and nuclear medicine" — Jamie Nathan (clinical) [Ep 1 · 5:17](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=317)
- "Dr. Deb Elder is the endocrine director for the Pancreas Care Center and will join later in the event" — Jamie Nathan (clinical) [Ep 1 · 5:33](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=333)
- "Dr. Milton Smith is medical director of therapeutic ERCP at University of Cincinnati and will join later in the event" — Jamie Nathan (clinical) [Ep 1 · 5:47](https://qa.library.globalcastmd.com/watch/welcome-and-introductions-pancreatic-disease-969?t=347)
- "TPIAT is indicated for chronic pain unresponsive to optimal medical and endoscopic approaches or surgical approaches and significantly impaired quality of life with repeated acute pancreatitis episodes, repeated admissions, missed school or work." — Joe Palermo (guideline) [Ep 2 · 5:28](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=328)
- "The main indication for TPIAT is chronic pain, not the transplant outcome; the primary goal is pain relief and full function, with insulin independence being secondary." — Jamie (opinion) [Ep 2 · 20:31](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1231)
- "TPIAT criteria include diagnosis of acute recurrent pancreatitis or chronic pancreatitis, chronic pain of greater than 6 months duration with either daily opioid use or severely impaired quality of life, absence of reversible cause, failure of medical or endoscopic intervention, and adequate beta cell function." — Jamie (guideline) [Ep 2 · 23:20](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1400)
- "Contraindications to islet autotransplantation include pre-existing insulin dependent diabetes mellitus, liver disease with portal hypertension or portal vein thrombosis." — Jamie (guideline) [Ep 2 · 23:59](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1439)
- "Patients with central sensitization of pain, functional pain disorders, drug seeking behavior, or severe psychosocial maladaptation do not do as well after TPIAT." — Jamie (clinical) [Ep 2 · 24:35](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1475)
- "Prior ductal drainage procedures and distal pancreatectomy compromise islet yield." — Jamie (clinical) [Ep 2 · 29:41](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1781)
- "Surgical drainage procedures are avoided in patients anticipated to require future TPIAT, particularly those with genetic etiologies." — Jamie (guideline) [Ep 2 · 29:50](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1790)
- "Portal vein pressures exceeding 25 centimeters of water pressure are associated with higher risk of portal vein thrombosis post TPIAT." — Jamie (clinical) [Ep 2 · 31:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1905)
- "Tight glucose control between 80 and 120 is critical postoperatively to protect from toxic hyperglycemia, as islets do not resume function immediately and rely on diffusion of nutrients and oxygen until neovascularization occurs over weeks to months." — Jamie (clinical) [Ep 2 · 32:43](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1963)
- "Up to 85-90% of TPIAT patients can achieve opioid independence, with most improvement occurring over the first several months." — Jamie (epidemiological) [Ep 2 · 36:56](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2216)
- "In children, 40% of TPIAT patients achieve insulin independence (typically over the first 12 months), 30% have partial graft function requiring basal insulin only, and 30% require basal-bolus insulin." — Jamie (epidemiological) [Ep 2 · 37:37](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2257)
- "Data from Minnesota shows the best outcomes in patients under 12 years old, with up to 55% insulin independence rate." — Jamie (epidemiological) [Ep 2 · 37:57](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2277)
- "Higher replicatory capacity of islets in younger children and possible islet neogenesis of ductal origin may explain better outcomes in younger patients." — Jamie (clinical) [Ep 2 · 38:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2294)
- "Islet function has been shown to be durable in children for as long as 10 years post TPIAT and is especially good for patients under 21 or with a short history of pancreatic disease." — Jamie (epidemiological) [Ep 2 · 38:26](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2306)
- "All TPIAT patients have delayed gastric emptying that resolves in several weeks, typically by 3-5 weeks." — Jamie (clinical) [Ep 2 · 30:41](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1841)
- "Complications occur in 15-20% of TPIAT cases, including bleeding (5-7%), abscesses, wound infections, bowel obstructions, portal vein thrombosis, and anastomotic leaks." — Jamie (epidemiological) [Ep 2 · 36:16](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2176)
- "Type 3C diabetes describes a pancreatic form of diabetes that is insulin deficient (unlike type 1 autoimmune or type 2 insulin resistant), must meet ADA criteria for diabetes, has negative islet antibodies, and requires insulin therapy not oral hypoglycemic agents." — Deb Elder (clinical) [Ep 2 · 11:05](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=665)
- "A normal peak insulin response to oral glucose tolerance load is typically at 30 minutes; a delayed peak at 60 minutes with blood sugar rising to 150 indicates subtle abnormalities in insulin secretion." — Deb Elder (clinical) [Ep 2 · 12:21](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=741)
- "Brittle diabetes, describing unpredictable extreme highs and lows, is reported in less than 1% of type 1 diabetes patients, and recent studies comparing total pancreatectomy patients with type 1 patients show no difference in complications." — Deb Elder (epidemiological) [Ep 2 · 21:33](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1293)
- "Tramadol is useful for mild to moderate pain because it does not generally slow gut motility as much as conventional opioids." — Ken Goldschneider (clinical) [Ep 2 · 16:42](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1002)
- "Sensitization in both the enteric and central nervous system from repeated inflammatory insults can lead to pain when all enzymes are normal, which is treated with neuropathic medications like tricyclic antidepressants and gabapentin, not opioids." — Ken Goldschneider (clinical) [Ep 2 · 17:33](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1053)
- "Splenectomy is performed routinely for TPIAT; attempts to preserve the spleen risk warm ischemia to islets during dissection and potential splenic infarction if relying only on short gastric vessels." — Jamie (clinical) [Ep 2 · 27:22](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1642)
- "Significant thrombocytosis occurs after TPIAT, likely not just related to splenectomy but possibly due to increased thrombopoietin levels produced by hepatocytes." — Jamie (clinical) [Ep 2 · 35:49](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2149)
- "Insulin independence is dependent on the number of islet equivalents transplanted, and there is a relationship between islet yield and severity of chronic pancreatitic changes by imaging or histopathology." — Jamie (clinical) [Ep 2 · 29:19](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1759)
- "Heparin anticoagulation is maintained intraoperatively and for one week postoperatively to prevent portal vein thrombosis from islet infusion." — Jamie (guideline) [Ep 2 · 31:38](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1898)
- "Dexamethasone infusion is used for the first 2 days postoperatively to decrease the instant blood mediated inflammatory response which has a potentially detrimental effect on islets." — Jamie (guideline) [Ep 2 · 33:17](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=1997)
- "Acetaminophen is not used postoperatively because some continuous glucose monitoring systems will read falsely with it." — Ken Goldschneider (clinical) [Ep 2 · 34:31](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2071)
- "The expectation is to wean patients off opioids postoperatively because there is no pancreas to have acute inflammatory disorders, and visceral hyperalgesia from sensitization should not be treated with opioids." — Ken Goldschneider (opinion) [Ep 2 · 41:34](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-pancreatic-disease-973?t=2494)
- "TPIAT is one of the most complex abdominal surgical procedures performed in children." — Juan Gurria (opinion) [Ep 3 · 0:48](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=48)
- "Surgical indications for TPIAT are for patients with either chronic or acute recurrent pancreatitis." — Juan Gurria (clinical) [Ep 3 · 0:54](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=54)
- "Patients are candidates for TPIAT when all medical and endoscopic therapy has failed." — Juan Gurria (guideline) [Ep 3 · 1:02](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=62)
- "TPIAT patients usually have a genetic mutation that drives the disease." (host_summary) [Ep 3 · 1:08](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "TPIAT patients typically present with chronic debilitating pain that can lead to opioid addiction or severe impairment of their mental health." (host_summary) [Ep 3 · 1:08](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=68)
- "The Pancreas Care Center team includes GI, social worker, endocrine, surgery, radiology, genetics, behavioral health, physical therapy, anesthesia, and pain team." — Juan Gurria (clinical) [Ep 3 · 1:23](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=83)
- "The entire team reviews and votes patients in for surgery to determine if they are candidates for TPIAT." — Juan Gurria (clinical) [Ep 3 · 1:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=105)
- "Patients are prepared with vaccinations for potential splenectomy before TPIAT surgery." — Juan Gurria (clinical) [Ep 3 · 1:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=105)
- "Pain catheters are placed in the transversus abdominis muscle by pain specialists." — Juan Gurria (clinical) [Ep 3 · 2:40](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=160)
- "A central venous catheter is placed using ultrasound for vein puncture and fluoroscopy for appropriate insertion." (host_summary) [Ep 3 · 2:46](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=166)
- "The pancreas in TPIAT patients has been injured for sometimes years, which makes the procedure quite challenging." — Juan Gurria (clinical) [Ep 3 · 3:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=194)
- "The procedure begins by mobilizing all organs from the left side of the abdomen, including the colon, stomach, and spleen." (host_summary) [Ep 3 · 3:21](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=201)
- "On the right side, the small intestine (duodenum) and liver hilum are mobilized, with careful identification of bile ducts and blood supply to the liver." — Juan Gurria (clinical) [Ep 3 · 3:29](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=209)
- "The pancreas is disconnected from the GI tract at two places: after the pyloric muscle in the duodenum and downstream in the jejunum." (host_summary) [Ep 3 · 3:43](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=223)
- "Blood supply to the head and entire body of the pancreas is preserved very carefully until the very last moment to avoid hypoxia of islet cells." — Juan Gurria (clinical) [Ep 3 · 4:06](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=246)
- "The lab cleans the pancreas by removing blood vessels, fat tissue, adipose tissue, and connective tissue." — Rita Bottino (clinical) [Ep 3 · 4:51](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=291)
- "Pancreatic ducts are isolated and cannulated to inject exocrine enzymes like collagenases and neutral proteases that break down the extracellular matrix holding cells together." — Rita Bottino (clinical) [Ep 3 · 4:51](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=291)
- "Injecting digestive enzymes into the pancreatic duct disintegrates the extracellular matrix, releasing islet cells and exocrine cells and turning the organ from solid to liquid form." (host_summary) [Ep 3 · 5:24](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=324)
- "Islets can be further separated from acinar cells if necessary." — Rita Bottino (clinical) [Ep 3 · 5:39](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=339)
- "The main goal is to bring back to the operating table the highest number of islets possible because islet number correlates with good outcome." — Rita Bottino (clinical) [Ep 3 · 5:45](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=345)
- "The maximum infusion volume is 5 mL per bag and 3 bags per patient to control the amount infused into the portal vein." (host_summary) [Ep 3 · 5:59](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=359)
- "The lab brings back to the operating room 1, 2, or 3 bags containing cells suspended in medium with albumin, heparin, and antibiotics." — Rita Bottino (clinical) [Ep 3 · 6:14](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=374)
- "During islet processing, the surgical team performs reconstruction of the gastrointestinal tract by bringing a loop of duodenum up to the bile duct and reconnecting another loop of intestine to the duodenum past the pyloric muscle." — Juan Gurria (clinical) [Ep 3 · 6:33](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=393)
- "A feeding tube is placed to allow patients to be fed while important connections heal." — Juan Gurria (clinical) [Ep 3 · 6:53](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=413)
- "Drains are left where the spleen was removed and on top of the connection with the biliary tract." — Juan Gurria (clinical) [Ep 3 · 7:02](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=422)
- "Islet cells are transfused into the portal vein with the hope that they will implant in the liver and start producing insulin." — Juan Gurria (clinical) [Ep 3 · 7:15](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=435)
- "Portal vein pressures are constantly checked during islet infusion to prevent portal vein thrombosis, which could cause significant morbidity." — Juan Gurria (clinical) [Ep 3 · 7:25](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=445)
- "Patients are placed in the intensive care unit post-operatively to control hemodynamics and fluid shift balance." — Juan Gurria (clinical) [Ep 3 · 8:01](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=481)
- "Islet cells need to heal in a very homeostatic environment, requiring close monitoring of vital signs." — Juan Gurria (clinical) [Ep 3 · 8:08](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=488)
- "Glucose and insulin are controlled via exogenous infusions post-operatively." — Juan Gurria (clinical) [Ep 3 · 8:18](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=498)
- "Close attention to nutrition is key in the healing of connections between the bile tract and gastrointestinal tract." — Juan Gurria (clinical) [Ep 3 · 8:22](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=502)
- "Patients are deemed ready for discharge when pain is well controlled, they are on full feeds (via tube or by mouth), glucose is well controlled via continuous glucose monitoring, and they have received full education." — Juan Gurria (clinical) [Ep 3 · 8:39](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=519)
- "After discharge, local GI physicians continue to follow patients along with the Cincinnati Children's team." — Juan Gurria (clinical) [Ep 3 · 8:47](https://qa.library.globalcastmd.com/watch/total-pancreatectomy-with-islet-autotransplantation-cincinnati-children-s-pancreas-care-center-9540?t=527)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: 1 item hidden — never mention Islet Cell / TPIAT; unhide from the owner view
- Aug 31: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 9 doctors auto-found from episode dossiers
- Aug 29: 9 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 5 items, 5 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 5 items, 5 dossiers, summaries for 3 audience(s)
- Aug 29: Collection generated from campaign corpus: 5 items, 5 dossiers, summaries for 1 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai