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Ontario patients with chronic pancreatitis can now access a new surgical treatment that can dramatically improve their quality of life.
The Ajmera Transplant Centre at UHN is the first in the province – and one of few centres in the world – to offer this procedure, allowing great relief for people suffering with this condition.
Two patients have successfully undergone the surgery called "total pancreatectomy and islet auto transplantation" (TPIAT) at Toronto General Hospital.
The procedure consists of removing the patient's pancreas, isolating the insulin-producing islet cells from the diseased pancreas, and then re-implanting them in the patient's liver.
The technique creates a "super liver" – the organ will continue to perform liver functions, but also by engrafting the islets of the pancreas, produces insulin and other hormones important in regulating blood glucose levels, explains Dr. Trevor Reichman, Director of the Pancreas and Islet Transplant Program.
"This procedure allows us to remove the pancreas, which is the source of these patients' pain, and preserve functioning islet cells that are essential for our bodies to function," says Dr. Reichman.
"It is a real game-changer for patients."
Living with excruciating pain
Patients with chronic pancreatitis have frequent, very painful crisis. That happens because they have a chronic inflammatory process in their pancreas.
"I basically lived in the hospital before I had the surgery," says Kaitlin Saari, a 28-year-old patient who had the procedure in March.
"Each episode would get me curled up on the floor with a stabbing pain, like someone had just kicked me in the ribs."
In the past, patients had few options for durable relief from pancreatitis. They often had to live with debilitating pain and depended on strong pain medications to get by.
Removing the pancreas was a last resort, but without any insulin-producing cells, patients developed another debilitating condition – brittle diabetes.
Healthy until his 50-year-old check-up, Christophe Kirch also suddenly started having episodes of severe abdominal pain. He had a long journey from one doctor to another, before becoming the first patient in Ontario to undergo TPIAT at the Ajmera Transplant Centre. The surgery was in November.
"I was going through excruciating pain, in and out of the hospital every month – sometimes even twice a month, and pain medication could only go so far," he says.
"Although this surgery was very new, I knew I needed this procedure. It was the only option for me."
Christophe and Kaitlin are recovering well and feeling much better.
Christophe still requires some insulin replacement, which was expected given the degree of damage to his pancreas. He has still maintained some glucose regulation from the islet cells implanted to his liver, making his blood glucose levels much easier to regulate.
Kaitlin's pancreas has yielded enough healthy islet cells for her to be completely insulin independent.
"The results of the surgery have been way beyond our expectations," Kaitlin says. "Of course, there's a long recovery journey, but it's been just a great relief pain wise."
Science at its best
Both patients have dramatically improved quality of life because of the innovative surgery they have received at UHN's Ajmera Transplant Centre, part of the new Islet Cell Transplant Program.
"This procedure is life-altering for our patients, who have been suffering from a very painful condition and had no good treatment options," says Dr. Atul Humar, Medical Director of the Ajmera Transplant Centre.
"Our culture of investing in talented researchers and physicians, as well as having state-of-the-art technology, allow us to keep pushing the envelope and doing what once seemed impossible."
The TPIAT procedure was possible due to the Ajmera Transplant Centre's continued investment in research and innovation, and collaboration with UHN Research.
The surgery lasts around 10 to 12 hours. After removing the pancreas in the Toronto General's operating rooms, the medical team takes the organ into the
Centre for Cell and Vector Production (CCVP) – a highly-specialized facility built in partnership with the
Centre for Commercialization of Regenerative Medicine (CCRM), and designed to be compliant with Health Canada mandated Good Manufacturing Practices to produce cell products for clinical purposes. It is located in the neighbouring MaRS building.
"When we partnered with CCRM to launch the Centre for Cell and Vector Production (CCVP) – the first facility of its kind in Toronto – we were filling a gap in Toronto to produce clinical-grade cells and viral vectors for clinical trials," says Dr. Brad Wouters, Executive Vice President, Science and Research at UHN.
"Our investment in this strong local ecosystem and our approach to team science have enabled the development of this innovative new therapy, to the benefit of Ontarians with pancreatitis."
In a CCVP clean room, the islet cells are isolated, purified and concentrated by validated and approved protocols, which prevent any contamination. The cells then return to the OR to be implanted into the patient's liver.
"This technology is helping us advance cell therapy," explains Dr. Reichman. "Our main goal is to advance islet cell transplantation and eventually be able to produce islet cells from stem cells, leading to a cure for diabetes."
This achievement was supported in part by generous donors through UHN Foundation.
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