Pancreas removal, and successful isolation and transplantation of insulin producing cells

A 21-year old Airman severely wounded in Afghanistan is recovering at Walter Reed Army Medical Center after several surgeries and an unprecedented transplant.

The procedure performed by medical teams at Walter Reed and the University of Miami's Miller School of Medicine, is the first known case of successful isolation and transplantation of insulin producing cells following severe trauma requiring complete removal of the pancreas.

When surgeons found the airman's pancreas to be damaged beyond repair by gunshot wounds and leaking pancreatic enzymes, which were dissolving critical abdominal structures and blood vessels, they had to remove the remaining portion of the pancreas to prevent further damage.

According to Army Col. (Dr.) Craig Shriver, chief of general surgery at Walter Reed and professor of surgery at Uniformed Services University in Bethesda, Md., this was the best decision to prevent further leakage, which could be fatal.

In islet transplantation surgery, the insulin producing islets are isolated from a donor pancreas and then reinfused in a patient's liver where they later begin to produce insulin.

As complete removal of the pancreas results in the most severe and life-threatening form of diabetes, the pancreas was packed in ice and transported by courier to the University of Miami. The organ arrived at 11 p.m., Nov. 23, the night before Thanksgiving.

Dr. Camillo Ricordi, professor of surgery at the Miller School of Medicine developed the method for isolating islet cells from the pancreas and is considered a pioneer in the field. He immediately agreed to help, in his words, "anything to help a wounded warrior."

A team led by Ricordi at the Diabetes Research Institute at the University of Miami spent the next six hours performing islet cell (insulin producing cells) isolation and purification. The purified islet cells were flown back to Walter Reed.

Late in the afternoon Nov. 24, Thanksgiving Day, the cells were successfully injected into the patient's liver, with the University of Miami team coordinating the procedure via an internet connection with surgeons at Walter Reed.

Less than one week after surgery, there was clear evidence of pancreas islet function in the wounded warrior's liver, as shown by the presence of a specialized blood test called c-peptide.

As time passes, the pancreatic islets in the liver will take up new blood supply, and the patient's requirement of exogenous insulin is expected to decrease, facilitating diabetes management and preventing the onset of complications of the disease, and ultimately improving his quality of life. Although the patient remains in intensive care for observation, he is stable and responding well to the procedure.