Total Pancreatectomy and Auto-Islet Transplant

A total pancreatectomy and auto-islet transplant is a treatment option for people with chronic pancreatitis (CP), or long-term inflammation of the pancreas that causes severe abdominal pain.

A total pancreatectomy — surgery to remove the entire pancreas — addresses the pain caused by the pancreatitis. However, removing your pancreas would lead to diabetes and require you to use insulin for survival. Transplanting your own islets — which are essential for insulin production — from your pancreas into your liver allows you to continue producing insulin. This reduces your risk of developing diabetes and the need for insulin.

UPMC specializes in performing this innovative, complex procedure, which improves the quality of life for people with CP.

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What Is A Total Pancreatectomy and Auto-Islet Transplant?

A total pancreatectomy and auto-islet transplant is a treatment option for people with chronic pancreatitis (CP), or long-term inflammation of the pancreas that causes severe abdominal pain.

 A total pancreatectomy — surgery to remove the entire pancreas — addresses the pain caused by pancreatitis. However, removing your pancreas would lead to diabetes and require you to use insulin for survival. Transplanting your own islets — which are essential for insulin production — from your pancreas into your liver allows you to continue producing insulin. This reduces your risk of developing diabetes and the need for insulin. 

Benefits of auto-islet transplant

Unlike other types of transplants, there's no waiting list for an auto-islet transplant. Since transplant surgeons use your own islets, you do not need to wait for a donor organ or tissue.

Other benefits of an auto-islet transplant may include:

• Avoiding a larger surgery later.
• Recovering faster.
• Restored quality of life shortly after the transplant.

Conditions we treat with total pancreatectomy and auto-islet transplant

• Chronic pancreatitis.

Why Would I Need A Total Pancreatectomy and Auto-Islet Transplant?

You may need a total pancreatectomy and auto-islet transplant if your pancreas needs to be removed due to severe abdominal pain caused by chronic pancreatitis or recurring episodes of acute pancreatitis. Without an auto-islet transplant, removing your pancreas would cause diabetes and require you to take insulin for the rest of your life.

An auto-islet transplant involves extracting islets from your pancreas after it has been removed. When your islets are transplanted into your liver, they may continue to produce insulin, reducing your risk of developing diabetes after your pancreas is removed.

Who’s a candidate for a total pancreatectomy and auto-islet transplant?

You may be a candidate for a total pancreatectomy and auto-islet transplant if you have symptoms of CP. The most common symptom of CP is severe pain in your abdomen that can spread to your back.

Other CP symptoms may include: 

• Nausea.
• Pasty gray stool.
• Vomiting.
• Weight loss.

What Are the Risks and Complications of Total Pancreatectomy and Auto-Islet Transplant?

Risks and complications of total pancreatectomy and auto-islet transplant include:

• Bleeding or blood clots.
• Development of diabetes.
• Infection.
• Ongoing pain and symptoms.

What Should I Expect From Total Pancreatectomy and Auto-Islet Transplant?

The first step in the process is for your doctor to refer you for a total pancreatectomy and auto-islet transplant evaluation. In most cases, your gastroenterologist will refer you to UPMC for pancreas transplant services. Early referral is crucial to minimize the damage to the islets.

Patient information review 

After the UPMC transplant team receives your medical records and information listed on the transplant referral checklist:

• A transplant nurse coordinator will collect your medical history, radiology studies, recent blood work, and current physical findings.
• The transplant team will review the information to determine if a transplant evaluation is appropriate.
• If a transplant evaluation is appropriate, we will obtain insurance authorization and contact you to schedule the evaluation.

Transplant evaluation and care team

During your evaluation, you'll have various diagnostic tests and meet with a number of experts from the transplant team, including:

• Behavioral health nurses or psychiatrists — Will assist you and your family in coping with the stresses associated with chronic disease and the transplant process. They will also assess any current psychiatric/mental health symptoms that are being treated or may need to be treated.
• Credit analysts — Review your insurance coverage and benefits information. They will help you to understand your insurance policy and will be your point of contact for insurance changes. They will also explain any parts of the transplant process that insurance does not cover and suggest options to assist with those costs.
• Endocrinologists — Will examine you, perform a medical history and physical, and manage diabetes if it develops after your transplant.
• Gastroenterologists — Diagnose, treat, and manage pancreas conditions.
• General surgeons — Assess your physical capability and risks for the procedure. They will review your diabetes management and address all treatment options available to see if an auto-islet transplant is the best option for you.
• Nutritionists — Assess your nutritional status, dietary knowledge, and provide education and recommendations for your diet.
• Pharmacists — Meet with you to get a complete list of all your medicines and supplements you take, both prescription and over the counter, and ask you how you take your medicines.
• Research transplant coordinators — Transplant nurses who coordinate and oversee patients who participate in research protocols for studies and clinical trials.
• Social workers — Discuss your support team at home, your prescription insurance coverage, and other social aspects of the transplant process. You will also learn about fundraising options.
• Transplant nurse coordinators — Introduce you to the transplant process and review your evaluation schedule. The visit will include a preliminary health screening, a review of your medication, and an overview of the transplant process. Your transplant nurse coordinator is here to answer any questions you may have.
• Transplant surgeons — Specialize in isolating and removing islets from your pancreas after it has been removed and transplanting the islets into your liver.

Transplant evaluation testing

Testing will include:

• Blood tests — To determine your blood type and check for signs of disease, infection, or other problems.
• Cardiac (heart) tests— To make sure your heart is healthy before surgery.
• Imaging tests — To assess your abdominal organs and look for signs of other health problems.

After your transplant evaluation

A multidisciplinary team will review your case at a selection meeting and decide on approval of your procedure. We will notify you of our decision shortly after the evaluation.

How much does a total pancreatectomy and auto-islet transplant cost?

The cost of a total pancreatectomy and auto-islet transplant can vary from patient to patient, depending on insurance coverage and other factors. If you wish to discuss the estimated cost, you will be given contact information for patient business services and a transplant credit analyst.

Before: How to prepare for total pancreatectomy and auto-islet transplant

To prepare for the procedure, you should:

• Fast for a certain period of time before the procedure. Your doctor will tell you if you need to fast or how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test before the procedure to determine how long it takes your blood to clot.
• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have any other health conditions. Your care team may need to take certain precautions during your procedure for your safety.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. You may need to stop some of the medications before the procedure.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home. 

You will spend about two weeks in the hospital after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You will need to arrange for someone to drive you home after you are discharged.

When you arrive at UPMC for your scheduled procedure, we will admit you to a patient room where you will:

• Have a history and physical done.
• Have basic testing.
• See an anesthesiologist.
• Sign consent forms for the procedure.

We will prepare you for your procedure and give you general anesthesia.

How long does total pancreatectomy and auto-islet transplant take?

Total pancreatectomy and auto-islet transplant takes about six hours.

During your total pancreatectomy and auto-islet transplant

During a total pancreatectomy and auto-islet transplant, your surgeon will perform the following steps:

• Make an incision in your abdomen.
• Remove your pancreas.
• Send your pancreas to the lab so islets can be removed.
• Reconstruct your digestive tract.
• Inject the extracted islets into your liver.
• Close the incision.

Your coordinator or surgeon will be able to provide more details about your specific surgery.

Recovery after total pancreatectomy and auto-islet transplant

After your procedure, you will spend a few days in the intensive care unit (ICU) before being transferred to a regular hospital room. You will spend a total of about two weeks in the hospital. 

Your care team will monitor your blood sugar levels to make sure your islets start to produce insulin. You will not need to take antirejection medications after an auto-islet transplant because the islets came from your body.

Going home from the hospital

Before leaving the hospital, your care team will review your:

• Activity restrictions.
• Blood test schedule.
• Diet and exercise guidelines.
• Follow-up visit schedule.
• Medication schedule.

Be sure you and your care partner fully understand your at-home care plan before you leave the hospital.

You'll also need to care for the incision site to prevent infection. Follow the directions your nurse gave you before leaving the hospital.

Your follow-up appointments

At first, you will have frequent follow-up visits so the transplant team can make sure you're recovering properly. That's why you will need to remain within one hour of UPMC for at least three to four weeks after discharge or as directed by your transplant team.

You must also have a care partner with you at all times during these first few weeks. Family House offers a "home away from home" near the hospital until you're ready to return home. It is not a medical facility.

After that, you will return to UPMC's post-transplant clinic at least every few months for the first year.

Our team at UPMC will take care of you for at least the first two years following transplantation, and ideally for life. In some special circumstances, you may be able to find a local transplant center that can take care of you.

Learn more about traveling to Pittsburgh for transplant services.

Your recovery at home

Most people who receive an auto-islet transplant at UPMC have good results and can gradually return to their normal routines within six to eight weeks. You will need to work with your doctor to manage your blood sugar levels and insulin needs. 

It’s important to follow your treatment plan and maintain a healthy lifestyle. Be sure to:

• Take all medications as prescribed — If you have any questions, call our office.
• Stick with your personalized nutrition plan — Follow the recommendations your nutritionist created for you, based on your medications.
• Avoid all nicotine products — This includes cigarettes, cigars, smokeless tobacco, e-cigarettes, nicotine patches, gum, or any other form of pharmaceutical nicotine. You should also avoid all forms of vaping, even if products claim to be nicotine-free.
• Exercise regularly — Begin with short walks, as you're able.

Remember that the UPMC pancreas transplant team is here for you for the rest of your life.

When to call your doctor about complications

You should let your surgeon know if you have:

• A fever of more than 100.0°F.
• Difficulty breathing.
• Numbness, tingling, pain, swelling, or weakness in your arms or legs.
• Pain, redness, bleeding, drainage, or increased swelling at your surgical site.
• Severe pain that does not respond to medication.

What’s the success rate of total pancreatectomy and auto-islet transplant?

Research shows that more than 80% of people who have a total pancreatectomy and auto-islet transplant experience significant pain relief — even 10 years after surgery.

About one-third of people who have the procedure will need long-term insulin therapy, one-third will require minimal insulin, and one-third will not need insulin at all. However, over time, it is possible for people who didn’t initially need insulin to require insulin therapy.

Why Choose UPMC for Total Pancreatectomy and Auto-Islet Transplant?

When you choose UPMC for total pancreatectomy and auto-islet transplant care, you will receive:

• Access to experienced, board-certified specialists — As one of the nation’s most active and experienced transplant programs, the UPMC Transplant Program is experienced in auto-islet transplant care and research.
• Outstanding transplant results — UPMC delivers auto-islet transplant outcomes that are consistent with or exceed national averages.
• Expert care for complex cases — Our multidisciplinary team provides a lifetime of comprehensive care for people who undergo total pancreatectomy and auto-islet transplant.

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By UPMC Editorial Staff. Last reviewed on 2025-12-09.