5-year-old is thriving after total pancreatectomy and islet auto-transplant
Warren Onstot was only 10 months old when he cried out with excruciating pain and started vomiting. His parents suspected it was pancreatitis, a condition that runs in his family.
Pancreatitis is inflammation of the pancreas, the organ that helps digest food and produces insulin to control blood-sugar levels.
Warren’s parents took him to a children’s hospital near their home in Iowa that confirmed the diagnosis. There, Warren was given pain medication and temporarily put on an all-liquid diet, so his pancreas could heal. But the saga didn't end there. Warren continued to have frequent, unexpected pancreatitis attacks for the next three years. Due to the damage, his pancreas wasn’t fully able to produce enzymes that help digest food, which meant his condition was chronic.
“He had a lot of pain,” Warren's mother Kristi said. “It got to the point where he was losing weight, and we couldn’t get him to gain weight. His quality of life was so poor, and we struggled to get him out of the house."
In November of 2023, the family went to a children’s hospital where doctors found that a duct in Warren’s pancreas had swollen up to 11.5 millimeters, which is extremely large for a child Warren’s size. Doctors put a stent in to narrow the opening.
A day after the stent was placed, Warren experienced what Kristi called “the worst pain that I have ever seen him in.” Warren was in the hospital another week or two before going home, but his pain didn’t go away, Kristi said.
A long history of pancreatic care in Minnesota.
Warren ended up back at the hospital in Des Moines in February 2024. This time, his doctor insisted that Warren go to M Health Fairview Masonic Children’s Hospital in Minneapolis. This is where Kristi wanted her son to go in the first place because M Health Fairview is a national leader in pancreatitis care and had helped members of Warren’s extended family.
In 1977, David Sutherland, MD, PhD, performed the world’s first total pancreatectomy and islet auto-transplant (TP-IAT) procedure – right here in our health system. To date, our doctors have performed 849 procedures, more than any other medical institution. In 2014, Srinath Chinnakotla, MD, a pediatric transplant surgeon with M Health Fairview and professor at the University of Minnesota Medical School, conducted the world’s first TP-IAT procedure on a 3-year-old child.
Children often do better than adults after a TP-IAT procedure, Chinnakotla said. They can go on to have a higher quality of life without the need for insulin injections. M Health Fairview Masonic Children’s Hospital is one of the few centers in the United States to perform TP-IAT successfully in young children with hereditary pancreatitis.
“There is still a lot of trepidation among pediatric gastroenterologists to send people for this surgery, but we’ve found that it’s safe for young children who see excellent outcomes,” Chinnakotla said. “We feel confident that TP-IAT is a good option for people who have experienced failure of medical and endoscopic treatments for chronic pancreatitis.”
