09:48pm Wednesday 23 August 2017

New England Journal Highlights DRI’s Historic Islet Transplant

The letter reports how a U.S. Air Force airman critically wounded in Afghanistan became the first known recipient of a successful islet transplant from a pancreas damaged by and removed after trauma. Performed at Walter Reed in Washington, D.C., last Thanksgiving Day with islets isolated and purified at the DRI in Miami, the autologous transplant saved Tre Porfirio from a life with severe diabetes, and offers the same promise for other trauma patients whose vital insulin-producing organ is damaged beyond repair.

“In this patient, we were able to isolate and transplant insulin-producing cells after a severe trauma requiring complete removal of the pancreas,” the authors wrote in the letter. “This procedure may prevent diabetes and secondary complications if even a small portion of pancreas can be salvaged.”

Submitted by Rahul M. Jindal, M.D., Ph.D., of Walter Reed, Camillo Ricordi, M.D., professor of surgery and director of the DRI, and Craig D. Shriver, M.D., also of Walter Reed, the correspondence sends an important message to surgeons everywhere: Never discard a damaged pancreas.

“Every physician, surgeon and center should know in cases where the pancreas needs to be removed from chronic pancreatitis or from trauma, it should be saved,” said Ricordi, who invented the machine and method for isolating large numbers of islets and transplanting them into the liver to reverse diabetes. “We can process the pancreas and re-purify the insulin-producing cells and return them to the patients so they will be cured of one of the most severe forms of diabetes. Anyone within a six-hour flight could be assisted.” Five days before Thanksgiving, Porfirio, a 21-year-old senior airman from Georgia, was shot in the back three times by an insurgent who crept up behind him on a remote U.S. Army outpost. His badly damaged pancreas was partially removed before he was airlifted to Walter Reed, where, the day before Thanksgiving, surgeons reluctantly removed the rest of it, instantly consigning the airman to one of the most severe forms of diabetes.

But, fortunately, Jindal, a Walter Reed transplant surgeon and clinical professor of surgery at George Washington University with experience in islet cell transplantation, recommended asking the man who invented the procedure for help.

Ricordi didn’t hesitate. “Anything for a wounded warrior,” he said, alerting his DRI team that Porfirio’s pancreas was on its way to Miami and they would work through the night to isolate and purify his islets. By Thanksgiving afternoon, Walter Reed doctors had more than 220,000 of Porfirio’s islets suspended in a Ricordi infusion bag and, with Ricordi’s remote telemedicine-assisted guidance, began injecting them into the Air Force enlistee’s liver via his portal vein.

Three weeks later, Porfirio’s liver was producing insulin in the normal range; soon after, doctors were able to discontinue his insulin.

The cooperative transplant also was successful in showing, the doctors wrote, “the feasibility of sending a pancreas to a remote location for islet isolation and purification and then transporting the islets back for successful infusion within 24 hours.”

To read the letter, which appears under the title “Autologous Pancreatic Islet Transplantation for Severe Trauma,” please visit the Journal.


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