title: Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest.
abstract: METHODS
  Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure used to treat severe complications of chronic pancreatitis or very high risk of pancreatic cancer while reducing the risk of severe diabetes mellitus. However, clear guidance on indications, contraindications, evaluation, timing, and follow-up are lacking.
  
  
  METHODS
  A working group reviewed the medical, psychological, and surgical options and supporting literature related to TPIAT for a consensus meeting during PancreasFest.
  
  
  RESULTS
  Five major areas requiring clinical evaluation and management were addressed: These included: 1) indications for TPIAT; 2) contraindications for TPIAT; 3) optimal timing of the procedure; 4) need for a multi-disciplinary team and the roles of the members; 5) life-long management issues following TPIAP including diabetes monitoring and nutrition evaluation.
  
  
  CONCLUSIONS
  TPIAT is an effective method of managing the disabling complications of chronic pancreatitis and risk of pancreatic cancer in very high risk patients. Careful evaluation and long-term management of candidate patients by qualified multidisciplinary teams is required. Multiple recommendations for further research were also identified.
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. Electronic address: bell0130@umn.edu.
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Gelrud
authors.affiliation: Department of Medicine, University of Pittsburgh, PA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.affiliation: Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Alfred
authors.initials: A
authors.lastname: Clavel
authors.affiliation: Department of Surgery, University of Pittsburgh, PA, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schwarzenberg
authors.affiliation: Department of Pediatrics, University of Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, PA, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Lowe
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Rickels
authors.affiliation: Department of Medicine, University of Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
authors.affiliation: Department of Surgery, University of Chicago, Chicago, IL, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Matthews
authors.forename: Stephen
authors.initials: S
authors.lastname: Amann
authors.forename: Dana K
authors.initials: DK
authors.lastname: Andersen
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.forename: John
authors.initials: J
authors.lastname: Baillie
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Block
authors.forename: Randall
authors.initials: R
authors.lastname: Brand
authors.forename: Suresh
authors.initials: S
authors.lastname: Chari
authors.forename: Marie
authors.initials: M
authors.lastname: Cook
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Cote
authors.forename: Ty
authors.initials: T
authors.lastname: Dunn
authors.forename: Luca
authors.initials: L
authors.lastname: Frulloni
authors.forename: Julia B
authors.initials: JB
authors.lastname: Greer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hollingsworth
authors.forename: Kyung Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Alexander
authors.initials: A
authors.lastname: Larson
authors.forename: Markus M
authors.initials: MM
authors.lastname: Lerch
authors.forename: Tom
authors.initials: T
authors.lastname: Lin
authors.forename: Thiruvengadam
authors.initials: T
authors.lastname: Muniraj
authors.forename: R Paul
authors.initials: RP
authors.lastname: Robertson
authors.forename: Seth
authors.initials: S
authors.lastname: Sclair
authors.forename: Shalinender
authors.initials: S
authors.lastname: Singh
authors.forename: Rachelle
authors.initials: R
authors.lastname: Stopczynski
authors.forename: Frederico G S
authors.initials: FG
authors.lastname: Toledo
authors.forename: Charles Melbern
authors.initials: CM
authors.lastname: Wilcox
authors.forename: John
authors.initials: J
authors.lastname: Windsor
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
mesh_terms: D000075202:Contraindications; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000209:etiology / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000601:surgery*; D012306:Risk; D014182:Transplantation, Autologous
keywords: Diabetes mellitus; Hereditary pancreatitis; Pancreatic adenocarcinoma; Pancreatic cancer; Pancreatic surgery