Need transplant, will travel
An innovative TP-IAT surgery pioneered at the University of Minnesota gave Julie Meek a new chance at life after pancreatitis—and now she’s giving back
“I feel 20 years younger.”
Julie Meek smiles ear to ear. Her secret? Having her pancreas removed at M Health Fairview University of Minnesota Medical Center.
In February 2021, the Indianapolis woman wound back the clock with a total pancreatectomy with islet autotransplant (TP-IAT). The innovative procedure was pioneered at the U of M in the late 1970s by David Sutherland, M.D., Ph.D., a professor emeritus in the Medical School’s Department of Surgery.
Today, the M Health Fairview program is not only the longest-running TP-IAT program in the world, but it also has treated upward of 800 patients—more than anywhere else.
In a TP-IAT, the pancreas is removed to take away the severe abdominal pain caused by pancreatitis. Then, through a specialized procedure, the organ’s insulin-producing islet cells are rescued and transplanted into the patient’s liver to prevent or reduce the burden of diabetes after surgery.
“The islet autotransplant was developed as a test model for cell therapy for type 1 diabetes. From there, we found it was remarkably valuable for disabling forms of pancreatitis,” says Melena Bellin, M.D., a professor in the Medical School departments of Surgery and Pediatrics and holder of the Albert D. and Eva J. Corniea Chair.
Bellin is a part of a multidisciplinary team focused on this procedure and made up of surgeons, gastroenterologists, endocrinologists, pain management experts, health psychologists, nurse coordinators, dietitians, and physical therapists.
The procedure changed Meek’s life. After being diagnosed with a congenital defect in her pancreatic duct at age 34, Meek spent more than three decades managing the problem through a series of stents, dietary adjustments, and medications. But by December 2019, Meek began experiencing symptoms of acute pancreatitis, and these medical management measures just weren’t cutting it anymore.
When an organ goes haywire
Those of us with a healthy pancreas move through our daily lives without ever considering it. Still, the pancreas dutifully churns to life at any given hour to infuse our food with enzymes that break down carbohydrates, proteins, and fats, transforming them into energy and sending waste on its way to the intestines.
But if the pancreatic duct is defective or gets clogged, digestive juices can’t travel their usual route through the body. Blocked fluids in the pancreas cause the whole system to break down.
Meek’s acute pancreatitis left her extremely fatigued. She was stuck in a holding pattern of eating a highly restrictive diet, being bedridden with severe pain, and making and canceling plans to see her grandchildren across the country.
“It was just sheer hell,” she says.
Meek’s concerned daughter-in-law, who leads the breast oncology program at the University of California San Francisco, recommended Meek see Mustafa Arain, M.D., a gastroenterologist there. Arain trained and worked at M Health Fairview University of Minnesota Medical Center with Greg Beilman, M.D., a professor in the University of Minnesota Medical School Department of Surgery and lead surgeon for the M Health Fairview TP-IAT program. Arain told Meek that she needed her pancreas out and Beilman was the best person in the world for the job.
“TP-IAT is the definitive, but very major, intervention that can help,” Bellin says.
In this procedure at M Health Fairview University of Minnesota Medical Center, a surgical team removes the patient’s pancreas, and a transport team swiftly takes it to the Molecular and Cellular Therapeutics (MCT) facility on the University’s Twin Cities campus in St. Paul.
There, experts isolate the organ’s insulin-producing islet tissue and mix it into a slurry.
The team then brings the tissue slurry back to the operating room in an IV bag, where surgeons infuse it into the patient via the portal vein outside the liver. Bellin says the portal vein works best because it branches into an intricate tangle of smaller blood vessels that deliver the slurry into the liver and ensure it cannot flow back out.
Onward and upward
Today, Meek’s life is transformed. She and her husband, Ted Meek, enjoy cooking and sharing meals with friends and going out on the town. And she’s back up and out of bed, traveling to San Francisco, St. Louis, and New York to see her far-flung grandchildren (pictured with Meek above and below) regularly.
Without a pancreas, Meek takes a shot of insulin each day and tracks her blood sugar levels.
“Islets have to settle in the liver,” Bellin says, “so everyone is on insulin for a few months after surgery.”
Eventually, about 30% of patients can come off insulin supplementation as their islets take over. Bellin says TP-IAT patients treated by M Health Fairview experts have stayed off insulin for anywhere between three to 20 years. Eventually, though, they’ll need supplemental insulin.
“It’s not the same as being fully reliant on it,” she says. “You can keep better control than when [surgeons] just take the pancreas [and don’t reinfuse the islets].”
Most of the remaining 70% of patients can cut back on their insulin intake as their islets kick in.
And to Meek, her daily insulin shot is “a piece of cake” compared to her life before the procedure.
The long game
Before she could return home postsurgery, Meek recovered at an apartment she and her husband rented in Minneapolis for more than two months. Bellin and her care team checked in on Meek daily.
“The team of caregivers, they’re sainted people,” Meek says. Bellin, Beilman, and nurses Louise Berry and Emily Scheidecker helped prepare Meek for surgery and offered a dedicated after-care period. “These people have devoted their lives to helping patients like me, and they go above and beyond.”
But the islet autotransplantation part of the TP-IAT is not covered by Medicare, Medicaid, or most insurance plans. And it costs more than $67,000. Plus, traveling to and staying in Minnesota for a couple of months drives the bill ever skyward.
“I’m just so blessed because we had the financial resources to pay for the islet autotransplant,” Meek says.
Now she wants to make this life-changing procedure accessible to more people.
Meek is working with Bellin and her colleagues to try to get the full TP-IAT procedure approved for Medicare and Medicaid coverage. Bellin and team are pursuing multiple short- and long-term studies that they hope will produce data to justify the medical and quality-of-life benefits. Bellin leads a multicenter study analyzing outcomes for roughly 400 patients. (Meek, of course, is participating in the research.)
A separate study Bellin is running will evaluate diabetes outcomes and islet function five to 20 years after the TP-IAT to measure long-term benefits.
In the meantime, Meek started a crowdfunding effort to raise $20,000 to help offset travel costs for others who need the procedure.
“At first, we just crowdsourced my friends and family,” she says. “Now we need to branch out.”
Plus, Meek just wants the world to know that M Health Fairview University of Minnesota Medical Center is the best there is at TP-IAT.
“There’s no equivocation about that,” she says. “Here my husband and I are lifelong Indiana University fans, and we wear University of Minnesota T-shirts, baby. And we wear [them] proudly, I’ll tell you!”