Our Patients, Breakthrough Innovation
800th TP-IAT surgery gives Idaho rodeo star a shot at life without chronic pain
For years, 21-year-old Rowdy Piva lived with the debilitating pain of chronic pancreatitis. This year, he became the 800th person to receive a total pancreatectomy and islet auto-transplant (TP-IAT) at our hospital.
- April 20, 2021
- By Staff Writer
21-year-old Rowdy Piva was an up-and-coming bull rider in Idaho before the severe pain of chronic pancreatitis sidelined him in 2019.
Piva, who won a statewide rodeo competition and earned a scholarship to be part of his university’s bull-riding team, had experienced attacks of severe abdominal pain caused by chronic pancreatitis since early childhood. But by 2019 he was experiencing them every month, each lasting up to a week.
Piva finally found a lasting solution early this year, when he became the 800th person to receive a total pancreatectomy and islet auto-transplant (TP-IAT) procedure at M Health Fairview University of Minnesota Medical Center. His surgery followed years of treatment at M Health Fairview University of Minnesota Masonic Children's Hospital.
A TP-IAT is a complex surgery involving the full or partial removal of several organs in the body, including complete removal of the pancreas. Removing the inflamed pancreas offers relief from the pain. Ordinarily, taking this step would immediately cause diabetes because cells in the pancreas produce insulin, which the body needs to process glucose. To prevent that from occurring, doctors isolate those insulin-producing cells in the pancreas and transplant them to the patient’s liver, where they continue to work.
Isolation of islet cells takes place in the Pancreatic Islet Cell Lab, a clean-room unit within the 40,000-square-foot Molecular and Cellular Therapeutics Facility at the University of Minnesota. There, the patient’s islet cells are isolated from the pancreas. Within a few hours, the islet cells are injected back into the patient’s liver, where they become connected to the blood supply and continue to produce insulin for the patient – even without a pancreas.
It may sound like science fiction, but it’s happening at M Health Fairview – and it has been happening here for more than 40 years. The TP-IAT procedure was developed by Transplant Surgeon David Sutherland, MD, PhD, in 1977 and M Health Fairview has since remained a world leader in this surgery. Our program is the largest in the world, treating more patients with debilitating pain caused by chronic pancreatitis than anywhere else on the globe.
Many chronic pancreatitis patients eventually need narcotics like opioids to cope with the pain. But after recovering from the TP-IAT surgery, most people no longer need pain medicine and go on to live a normal life. Daily insulin injections and enzyme pills before each meal enable the patient’s body to digest food normally. Once the patient’s islet cells begin producing insulin again, some patients’ blood sugar is well controlled even without insulin injections.
“This procedure can be technically challenging, but our team’s experience over the years has made it possible for us to succeed,” said Transplant Physician Bernhard Hering, MD, who serves as the executive director of the Schulze Diabetes Institute at the University of Minnesota and M Health Fairview’s director of islet transplantation. “We have close coordination before, during, and after the procedure between the pancreas surgeon and the islet team to increase the odds of a positive outcome for the recipient.”
Piva’s surgery was led by Critical Care Surgeon Greg Beilman, MD.
“I may be the person performing the surgery, but the credit really goes to our multidisciplinary team of endocrinologists, gastroenterologists, surgeons, pain doctors, nurses, the islet cell lab, and others who since 2006 have been working together to identify the right patients, do the right operations, help them with recovery, and conduct research to understand how we can do it even better next year,” Beilman said.
It’s a sentiment that rings true for Piva. “Everyone at M Health Fairview really cares about your well-being and wants to help you feel better. The atmosphere here was a lot different than at any other place. They just take such good care of you, and they make sure you know how to care for yourself.”
“Lastly, I want to recognize our patients, who come to us from all over the world because of the unique care we can provide,” Beilman said. “Our patients contribute to the future by helping us advance our research efforts. It’s a great example of the way the work we do at the university can make a big difference in patients’ lives.”
Now that Rowdy Piva is free from the pain of chronic pancreatitis, he remains focused on his recovery, building the strength and stamina he will need to return to the sport he loves. “I’m looking forward to feeling good enough to be capable of riding bulls again. It’s a difficult sport, one in which even the best in the world lose 50 percent of the time. But when you win, you feel 10 feet tall.”