Doctors perform groundbreaking surgery at Walter Reed
By Kristin Ellis , Walter Reed Army Medical Center
/ Published December 19, 2009
WASHINGTON (AFNS) -- 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.
Senior Airman Tre Porfirio, a 21-year-old communications technician deployed from Wright-Patterson Air Force Base, Ohio, was shot three times in the back by an insurgent Nov. 21 while serving with an Army unit in Afghanistan. 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.
Airman 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," Doctor 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.
During 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 Airman 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, a 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," Doctor 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," Doctor 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. Doctor Ricordi helped to coordinate the transplant with the surgeons through an Internet connection, and on Thanksgiving Day, Airman Porfirio's own cells were successfully injected into a vein to his liver.
Airman 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," Doctor Ricordi said.
(Courtesy of American Forces Press Service. Derek Kaufman from the 88th Air Base Wing Public Affairs Office contributed to this story.)