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Patients with chronic pancreatitis have benefited from total pancreatectomy and autologous islet cell transplantation (TPAIT) since the 1970s. Over the past few decades, improvements have been made in surgical technique and perioperative management that have led to improved success of islet cell function, insulin independence and patient survival. This article focuses on recent updates and advances for the TPAIT procedure that continue to expand and innovate the impact on patients with debilitating disease.

Total pancreatectomy and autologous islet cell transplantation (TPAIT) is an established treatment for chronic and recurrent acute pancreatitis. 1,2 The surgical procedure requires extensive dissection around the pancreas and infusion of isolated autologous islet cells through the portal vein for engraftment. 3 Success of the procedure is related to reducing morbidity by avoiding major complications such as bleeding, thrombosis, and infection, as well as ensuring a suitable environment within the liver for islet cell engraftment. Among the known complications, the most feared complication in the perioperative period is portal vein thrombosis (PVT), either segmentally or through the superior mesenteric axis. 4,5 To reduce the risk of this adverse outcome, various strategies including routine anticoagulation are employed, which is not without its own risk due to bleeding. Thrombosis in any vessel is related to Virchow's triad,

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