Walter Reed performs rare transplant of pancreas cells

By David Brown
Washington Post Staff Writer
Wednesday, December 16, 2009

A 21-year-old airman who was shot in the abdomen at a remote outpost in Afghanistan last month underwent a rare procedure at Walter Reed Army Medical Center in which cells were rescued from his severely damaged pancreas and transplanted into his liver.

The procedure has been done only about 200 times, and almost always for a severe disease called pancreatitis. Surgeons at Walter Reed think this was the first case of pancreatic "autotransplantation" after a traumatic injury, although that claim could not be independently verified.

The operation involved removing the airman's pancreas at Walter Reed; flying the organ to Miami, where the cells were extracted and preserved; and then returning the cells to Washington, where they were infused into the patient's liver. There the cells become permanent residents, secreting hormones into the bloodstream and performing part of the function of the original pancreas. The process occurred over less than 24 hours and involved about 60 people.

Among the servicemen and women wounded in the wars in Iraq and Afghanistan, Tre F. Porfirio, of St. Marys, Ga., was the first "eligible, or even considered, for a thing like this," said Craig D. Shriver, chief of general surgery at Walter Reed.

The procedure, which will be described in a surgical videoconference this week and eventually published in a journal, may be of use to civilian surgeons who treat devastating abdominal injuries.

"There is no reason a pancreas should ever be thrown away" before useful cells are harvested, said Camillo Ricordi, who heads the University of Miami's Diabetes Research Institute, where Porfirio's cells were extracted.

The pancreas is a zucchini-shaped organ in the middle of the abdomen. It produces insulin and glucagon, two hormones that regulate levels of sugar in the blood, as well as a large number of enzymes that digest starches, protein and fat from food.

Porfirio will have to take enzyme pills with meals for the rest of his life, but his doctors hope the transplant will give his body at least some ability to regulate blood sugar without being entirely dependent on insulin shots.

According to a press report, the airman was shot in the back three times by an insurgent. He underwent two operations in Afghanistan, including one that removed much of his pancreas, before being flown to Germany.

When Porfirio arrived at Walter Reed four days after the shooting, it became clear that his pancreas was continuing to leak digestive enzymes, which threatened other organs, and had to be removed, Shriver said in a news briefing Tuesday. Shriver then consulted another surgeon at Walter Reed, Rahul Jindal, who was familiar with transplantation experiments at the University of Miami's Miller School of Medicine.

Normally, this type of transplant is done on a nonemergency basis, and the patient travels to the place where the pancreatic cells are extracted and preserved. That was not possible in this case, so the remainder of Porfirio's pancreas was flown to Miami, arriving about 11 p.m. the day before Thanksgiving.

Ricordi's team worked through the night isolating and preserving the "islet cells," which produce insulin and glucagon. The cells arrived back in Washington at 3 p.m. on Thanksgiving and were transplanted. Tests show that the cells are producing insulin.

Speaking by telephone to reporters, the airman's father, Karl Porfirio, thanked the surgical teams and everyone who helped his son, "from the first soldier who touched him when he hit the ground."

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