The UNC Chronic Pancreatitis and Autologous Islet Cell Transplant Program, led by Chirag S. Desai, MD, FACS, professor of surgery, has performed its 100th case, cementing UNC Hospitals as one of the most significant centers for surgical therapy for chronic pancreatitis.
About four years ago, Paul Freeman’s life turned upside down. The now 32-year-old from Wilkesboro, NC, began to experience debilitating abdominal pain. Then, he started vomiting every day. Unable to keep food down and losing weight fast, Freeman was put on tube feeds and, eventually, had to receive vital nutrients from an intravenous (IV) line.
“I pretty much had a spell almost every month,” said Freeman. “I couldn’t eat anything by mouth for years. I eventually lost my job because I was bedridden from the pain, still vomiting, and couldn’t make it into work enough. My quality of life was very poor.”
He later found out that he was experiencing necrotizing pancreatitis, a severe condition in which inflammation causes parts of the pancreas to die. He needed a long-term solution, urgently. After being referred to UNC’s Chronic Pancreatitis and Autologous Islet Cell Transplant Program, Freeman now eats three meals a day, has a steady job, and can even see his daughters.
What is Chronic Pancreatitis?
Tucked behind the stomach and below the liver lies a club-shaped organ: the pancreas. Although it is just six-inches-long, this small organ has a big role to play in our bodies. It secretes hormones to keep our blood sugar in line and it secretes enzymes to help break down stomach contents to be properly absorbed in the small intestine.
Just like any organ, though, the pancreas is susceptible to widespread inflammation. Pancreatitis can affect certain parts or the entire organ. If the inflammation lasts long enough, it can become chronic, causing irreparable damage to the organ – including scarring, damage, and blockages in the ducts that secrete enzymes and hormones.
Chronic pancreatitis can happen to anyone, at any age. Long term alcohol use and the presence of an autoimmune disease, some genetic mutations can greatly increase one’s chances of experiencing chronic pancreatitis. But it can also erupt without a clear clinical cause.
Unfortunately, it is an incredibly challenging disease to diagnose and treat, often leaving patients to suffer for years without proper care. Many patients find themselves going from doctor to doctor and in and out of emergency rooms, desperate to find the source of their debilitating pain.
The Total Pancreatectomy and Autologous Islet Cell Transplant
In mid-2017 Chirag S. Desai, MD, FACS, professor of surgery and chief of abdominal transplant surgery in the UNC Department of Surgery, created The UNC Chronic Pancreatitis and Autologous Islet Cell Transplant Program to help patients suffering from chronic and recurrent acute pancreatitis get the care they need.
In patients with severe chronic pancreatitis and after medical interventions have been exhausted, they may need a total pancreatectomy and autologous islet cell transplant, or TPIAT. The surgical option is optimal for those experiencing debilitating pain and impaired quality of life from chronic pancreatitis.
The procedure involves removing either parts of the pancreas or the whole organ. Once removed, specialists harvest insulin-secreting islet cells from the healthy portions of the pancreas and reinfuse those cells into the patient’s liver, their new home. From there, the insulin-secreting islet cells can successfully do their jobs again, secreting insulin and managing sugar levels in the bloodstream.
Jill Hale, a 45-year-old woman from Fayetteville, NC, received a subtotal pancreatectomy and autologous islet cell transplant after several bouts of necrotizing pancreatitis caused a myriad of issues, including disconnected pancreatic duct syndrome, abdominal pain “like no other,” and the development of a fluid-filled pseudocyst outside of her pancreas.
After several emergency department visits that resulted in inpatient stays, it was time she looked into specialty care.
“On May 16, I went under the knife and my life changed,” said Hale. “I have not had to use any type of insulin since. I’m completely insulin independent and pain-free a year and a half post-surgery.”
Recently, the transplant program has completed 100 cases at UNC Hospitals, which makes UNC one of the most significant centers for surgical therapy for this disease. In 2022, the program was nationally recognized as a National Pancreas Foundation (NPF) Center of Excellence. NPF Centers of Excellence are premier healthcare facilities that focus on multidisciplinary treatment of pancreatitis, treating the “whole patient” with a focus on the best possible outcomes and an improved quality of life.
“When we started this program seven years ago, our goal was to provide personalized, state-of-the-art care by carefully selecting the most appropriate surgical option for each patient,” said Desai “We are committed to supporting our patients throughout their surgical journey, ensuring they could return to a meaningful quality of life.”
“Reaching the milestone of 100 cases is a testament to our vision of providing personalized, supportive care. We are proud to see so many of our patients thriving—whether by returning to work, continuing their education, or re-engaging with their communities,” said Desai.
An Emphasis on Care for the Whole Person
Receiving a transplant is an achievement, but recovery is another feat altogether.
Typically, patients spend 8-12 days in the hospital after a TPIAT. During this time, a coordinated team of surgeons, endocrinologists, and nutritionists monitor blood sugar levels and play an important role in preparing the patient for at-home recovery.
Jacob Barefoot, a 28-year-old from Goldsboro, NC, has an extensive history with pancreatitis. Pancreatic divisum, a common congenital disorder, caused multiple hospitalizations and a decreasing quality of life for him. He is thankful for the program and how much they showed concern with his overall health before and after surgery.
“After my surgery, I had an injury to my brachial plexus,” said Barefoot. “At my first post-op appointment, everyone was, of course, concerned for how the procedure went. But they also showed interest in the issues with my brachial plexus. Everyone was concerned about me, in general. And that has continued to be the case long-term. The team provided care far above and beyond the norm.”
Patients are also put in touch with a care coordinator, social worker, and dietitian to develop and review care plans pre- and post-surgery. Marilyn Hanson, RN, is the transplant nurse coordinator at the UNC Chronic Pancreatitis and Autologous Islet Cell Transplant Program. She has the very important task of following up with patients post-surgery to evaluate their health. And it is a task that she takes very seriously.
“After the surgery, Marilyn gives you her personal number and you have to text her every single day,” said Freeman. “If you don’t text, she will call until you pick up. That is one of the many ways that this group truly cares about you as a person. I wasn’t a statistic to them.”
If you have chronic or recurrent acute pancreatitis, talk to your doctor about treatment options or learn more about the Chronic Pancreatitis and Autologous Islet Cell Transplant Program. You can schedule a consultation or make a referral at 919-966-8008.
Media contact: Kendall Daniels Rovinsky, Communications Specialist, UNC Health | UNC School of Medicine