Gastrointestinal management after total pancreatectomy with islet autotransplantation (TPIAT) requires support in the immediate postoperative period for the dysmotility that results from enteric reconstruction and postoperative ileus, among other factors, and may be further aggravated by opioid-induced constipation. Gastrojejunal feeding tubes can allow early introduction of enteral nutrition if gastroparesis limits oral intake, allowing proximal decompression and distal feeding. Due to iatrogenic complete exocrine pancreatic insufficiency, TPIAT recipients will need lifelong pancreatic enzyme replacement therapy, as well as fat-soluble vitamin (FSV) replacement. Deficiencies of FSV and essential fatty acids can be encountered and should be screened for at regular intervals. A low-oxalate diet is encouraged to prevent kidney stone formation. Growth improvements have been observed after TPIAT, especially in children. As with any major abdominal operation, gastrointestinal symptoms related to the procedure may occur later in life. Because splenectomy usually accompanies TPIAT, vaccines are administered preoperatively, and children are started on antibiotic prophylaxis, generally for 1 year postoperatively. All are advised to seek emergent evaluation in the event of fevers due to the risk of overwhelming postsplenectomy infection.