[Inaudible].
TPI T the acronym, uh, spelled two different ways.
The first part TP refers to total pancreatectomy. So of course,
Pancras clan is a gland that situated behind the stomach.
And it has two main functions.
One is to produce enzymes that digest food and the other on the
surface are on the surface of the pancreas are little islands.
We call them islands of Lang hands after the person who described them.
And the second part of this surgery is take those little islands
from the pancreas.
Once the pancreas is outside the body and put them back in the body.
Uh, now usually when, when they're put back in, they go back into the liver.
This seems to be the best place for Eilis once they come away from the pancreas.
So in terms of the, uh, uh, the acronym,
it's either T P a I T I E a total
pancreatectomy and auto islet transplant,
or TPI 80 total pancreatectomy and islet
autotransplant.
And the auto refers to the fact that they are your own eyelids that go back into
your body,
as opposed to allotransplant where somebody else's organ goes into it. So this,
this is why it's a little bit convoluted, but the, the, the,
uh, but the, uh, but the, um,
surgery is very specific in that regard.
So what's the importance of the ALS why do we need to do this?
Why not just take out the pancreas if that's really the problem? Well,
the islands are unique in that they produce the insulin. And of course,
we all know the significance of insulin and diabetes as a huge problem,
both in children and adults throughout the world, the Alice structuring funds,
uh, are, uh, they produce the insulin that controls the glucose.
So if you lose the eyelids by say not,
reimplanted no more not putting them back in the body,
then you automatically can become a severe diabetic.
And that's important because the eyelids contain two types of cells, Bita cells,
which produce insulin and alpha cells, which produce the hormones,
the balanced insulin out. So it's not just that you bring,
you control the glucose one way by, by allowing by the insulin,
allowing it to go into organs and get utilized. But the other way, too,
that the insulin doesn't overwork so that, you know,
your blood sugar doesn't go too low.
So this as usual in the body is a dynamic situation where both
sides are actually controlled. Now, without the eyelids,
you become what we call a brittle diabetic with the shifts in glucose that you
get, you can of course die from severe hypoglycemia,
where the blood sugar is very low or get complications from hyperglycemia with
the blood sugar is very high for long periods of time. And of course, we,
a lot of us know a lot about this. Why?
Because we all know somebody who's a diabetic and the kind of problems they
usually have. So the, the, the, the whole,
uh, operative procedure is not really about the,
the taking out an organ, which of course happens for many reasons,
but replacing these important eyelids because they save saving from being
diabetic, if you would have your pancreas taken out.
[Inaudible].
Well, the main reason for considering TPIT is chronic
pancreatitis, which means, uh,
pancreatitis has been happening for more than three months. Now,
when the pancreas is actually inflamed,
I E the inflammatory component, which is in the pancreatitis, um,
it causes a lot of pain.
And the reason for this is that the pancreas normally produces, uh,
pancreatic enzymes. That actually,
when they occur in the wrong situation, they digest the pancreas itself.
That's the, that's what generates the pain.
Now that pain is so severe that most people end up on narcotics.
And while that's okay to have in short interval, say, after an operation,
when you have them chronically not only do you get labeled
as being a pain medication seeker,
but also you have complications of not narcotics themselves,
but most people on a chronic basis cannot survive without
getting rid of the cause of the pain, which is total pancreatectomy.
And of course the AIT part is stop you from becoming diabetic
by giving you your eyelids back.
[Inaudible].
Some outcome.
And the reason for this surgery in the first place is the chronic pain.
So what we tell people is often the first year from the transplant,
you should be able to, you should have weaned off the pain medication.
So you should be a nomad living a normal life,
which of course means going back to work and all those normal things that we do.
There's one important thing though,
that most people talk about and because it comes up,
and that is what are the chances of being a diabetic after a TPI T
and what we tell people that it depends on how,
how damaged your pancreas was at the time it came out. Obviously,
if you were having chronic pancreatitis 20 years versus say one or two years,
there's more chance to move.
The eyelids would have been destroyed in the chronic inflammatory process over
that time. So that will determine once the bank,
that will be determined once the, once the pancreas comes out,
but it may be that for one person only gets half or a third of
normal, a number of islands, as opposed to getting a normal number of islands.
And therefore those people will be at risk for developing
diabetes or needing some insulin, I should say,
because you're not truly diabetic, because you do have islands.
[Inaudible].
For most people, uh,
you should consider it once there's a diagnosis of chronic pancreatitis. So,
which means that you've had many months of pain. Now,
having said that there are underlying, uh,
the underlying problems to chronic pancreatitis, such as a atomical problem,
or the pancreas say, for instance, a goal goal stones can give you pancreatitis.
Well, of course the first thing would be to have the ghost turns removed.
So you need to be fully evaluated to know that we are in a
situation where you have chronic pancreatitis,
and there's no other option having said that most people wait too long
or that it, well, by the time they get to that procedure,
they've had many years, first of all, pain, secondly,
of narcotics and narcotic use. And of course the ability,
which means loss of a loss of livelihood and so forth.
So we always say is that considered early be evaluated?
And so therefore you are prepared and not to say that you would,
of course need the procedure as soon as possible,
but want is clear that you are in a chronic situation.
There are no other options.
That's when it that's when the surgery will be necessary.
[Inaudible].
Those centers for TPIT around the country,
but there are not a lot of centers. So you have,
you're limited in terms of where you want to go.
And of course it's important to go somewhere where there's comprehensive care.
So in that regard, if you look at, um, uh,
the Georgetown unit, we have a much wider, uh, uh,
surgical, um, expertise than most places.
Why? Because we do all rare and, uh,
complicated transplants here,
which are done in very few places around the country.
So it's not so much about being able to do a total pancreatectomy many places
can do that.
It is about being able to handle the most difficult
situations, and it's not clear who will be difficult, and you want, thirdly,
it's also important to have an excellent lab.
And we have one of the very few dedicated labs that actually, uh,
harvest islets from pancreatic, not only from,
for this procedure, but for other procedures as well. So that expertise,
I think, is vitally important to get as many ideas as possible for, for the, um,
to put back in the liver. And of course,
therefore reduces the chance of diabetes, uh, in general,
at MedStar in a, we have a wide, uh, you know, uh,
or comprehensive followup because we have not only a surgical team,
but also a medical team nutritionist and so forth. And we,
uh, ourselves we'll follow up or patients in the long term,
which I think is most important,
especially in the first year after this kind of surgery where most people have
issues. So when you put all that together,
I would suggest that of quest at MedStar or MTTI
or transplant Institute,
we really can provide the best care that practically anybody can.