Doctors Perform Groundbreaking Surgery at Walter Reed

American Forces Press Service ^ | Kristin Ellis

[SandRat]

WASHINGTON, Dec. 17, 2009 – Doctors from Walter Reed Army Medical Center here and the University of Miami collaborated to perform the first pancreas islet cell transplant Thanksgiving Day on an airman whose pancreas was injured so severely in Afghanistan that it had to be removed.

Army Col. (Dr.) Craig D. Shriver, chief of general surgery at Walter Reed Army Medical Center in Washington, D.C., describes groundbreaking pancreas islet cell transplant surgery performed Nov. 26, 2009, to reporters during a Dec. 15, 2009, news conference. Dr. Pascal Goldschmidt, dean of the Miller School of Medicine at the University of Miami, and Dr. Rahul Jindal, transplant surgeon, also were on hand to take reporters’ questions. Photo by Kristin Ellis, courtesy of Stripe  
(Click photo for screen-resolution image);high-resolution image available.

While serving with an Army unit in Afghanistan, 21-year-old Air Force Senior Airman Tre Porfirio was shot three times in the back by an insurgent Nov. 21. Seventy-two hours and 8,000 miles later, Porfirio was at Walter Reed with injuries so extensive it would require 11 surgeries to reconstruct his abdomen.

Porfirio was taken to the operating room where Army Col. (Dr.) Craig D. Shriver, chief of general surgery, found the pancreas damaged to the point it was leaking dangerous enzymes that were causing blood vessels and tissue to break down.

“The only possible course of action at the time was to remove the remainder of his pancreas, which would predictably lead to a severe form of life-threatening and lifestyle-limiting diabetes,” Shriver explained to reporters at a Dec. 15 news conference.

Risks for this type of diabetes include blindness, kidney failure, amputations and strokes, as well as daily insulin injections for the rest of his life.

Over the last eight years of war, doctors at Walter Reed have seen only 28 pancreatic injuries, and only one of this devastating nature, officials said. The surgical team called the University of Miami and put together a plan to ship the damaged pancreas to Florida to harvest the cells that produce insulin -- called islet cells -- and immediately ship them back to Walter Reed to be transplanted into Porfirio’s liver.

All of this had to be done overnight, the day before Thanksgiving.

“I knew who the main players were in this case,” said Dr. Rahul Jindal, transplant surgeon. “I picked up the phone and called [Dr. Camillo Ricordi, chief of cellular transplantation, University of Miami] and, without hesitation, he said, ‘For a wounded warrior, I’ll bring my whole team.’”

“Being able to serve a wounded warrior who risked his life to defend us all, I can think of no better way to spend Thanksgiving,” Ricordi said.

In islet cell transplantation, the insulin-producing islets are isolated from the donor pancreas and then re-infused in a patient’s liver, where they begin to produce insulin, doctors explained.

“You turn the liver into a double organ as it takes on the function of the pancreas,” Ricordi said. “Normally, when similar procedures are done for Type 1 diabetes, the cells come from another person, so you need immunosuppressant drugs to keep them alive. Since we were able to use his own cells, he won’t need to be on anti-rejection drugs.”

The University of Miami team spent six hours isolating the islet cells before they were suspended in a specialized cold solution and flown back to Walter Reed. Ricordi helped to coordinate the transplant with the surgeons through an Internet connection, and on Thanksgiving Day, Porfirio’s own cells were successfully injected into a vein to his liver.

Porfirio’s blood tests show his harvested islet cells are functioning well, and he is gaining back his strength every day, doctors said.

“For anyone within a six-hour flight range of Miami, there is no reason any pancreas should ever be thrown away,” Ricordi said.

(Kristin Ellis is a staff writer for Stripe, a civilian enterprise online publication serving Walter Reed Army Medical Center.)

[Carley]

Blessings on everyone involved.

Thank you for caring about our heroes.

Thank you thank you

[mtnwmn]

I wonder if this could be promising to pancreatic cancer patients as well?

[john drake]

Also for diabetics given it is the pancreas that produces insulin to self-control blood sugar naturally.

[GovernmentShrinker]

I was wondering that as well. But I’m not sure if pancreatic cancer is normally diagnosed before it has begun to spread elsewhere, or if cancer-free cells could be reliable harvested from a pancreas with sufficient cancer to have been diagnosable.

[oldvike]

All I can say is “wow”.

[GovernmentShrinker]

I also wonder if it could be used for Type I diabetics. That’s an autoimmune condition, so the body’s immune system is attacking its own islet cells, but I wonder if it would still attack them if they were located in the liver. If it’s possible to isolate some of these cells from a part of the pancreas while leaving the organ still functional, and transplant them to the liver, it should be possible to test the feasibility of this without destroying the patient’s pancreas (which is important for other things besides producing insulin).

It wouldn’t work for Type II diabetics, whose chief problem is insulin resistance rather than lack of normal insulin production. And of Type II, induced by overeating, is by far the most common type of diabetes in the developed world.

[nutmeg]

ping!

[Tolerance Sucks Rocks]

Heroes all.

Maryland PING!

[Dawgreg]

I’m thinking the same thing. Wouldn’t that be great?

[freekitty]

“I knew who the main players were in this case,” said Dr. Rahul Jindal, transplant surgeon. “I picked up the phone and called [Dr. Camillo Ricordi, chief of cellular transplantation, University of Miami] and, without hesitation, he said, ‘For a wounded warrior, I’ll bring my whole team.’”

Now, I am crying.

[DollyCali]

great article.. thanks

[SandRat]

[ASOC]

TOTALY cool - thanks for the post.

I'm old enuf to remember when PJs and Army medics came up with MAST ‘pants’ (Military Anti-shock Trousers -dunno what they call these days...). Seems the military is got some cutting edge stuff going on.

[chris_bdba]

This isn’t new surgery it’s been done beofre in other countries around the world for type 1 diabetics. The problem with it is because type 1 is an autoimmune diease it usually only lasts a few years before the islets are damaged again by the immune system.

[chris_bdba]

It’s already been done in Canada and a few other countires around the world for type 1 diabetics. he problem is that since type 1 is an autoimmune diease the best they have got was a 5 year sucess rate and after that they go back to being a type 1 again.

[chris_bdba]

OOPPPSSSI missed the “liver” part. The other surgeries I spoke of were repacing the islets in the pancerous.

[seekthetruth]

Thanks for the ping. What wonderful news! Prayers for all our wounded heroes! And God bless those wonderful doctors!

[stanz]

This is great news! My heart goes out to that brave serviceman. May he get stronger each day.

[freekitty]

Thank you SandRat.