Airman injured in Afghanistan gets a remote pancreas fix
Six days before Thanksgiving, Air Force Senior Airman Tre Francesco Porfirio was pulling duty in Afghanistan when three high-velocity bullets tore through his pancreas -- the fist-size organ that produces insulin and enzymes needed to extract fuel from food.
With an injury like that, Porfirio’s prognosis was difficult: If he could survive long enough to get to a specialized transplant center, he could perhaps get a transplant of islet cells from a deceased donor and take anti-rejection drugs for the rest of his life. Or doctors could remove his pancreas, leaving him completely dependent on insulin. Either way, an early death from complications of Type 1 diabetes was highly likely.
Instead, doctors improvised a way to help the serviceman and made Porfirio, 21, a pioneer in the technique of islet-cell transplantation.
On Tuesday, Dr. Camillo Ricordi, director of the University of Miami’s Diabetes Research Institute, described Porfirio’s long-distance islet-cell transplant. The experimental procedure is considered the best hope for treating patients whose pancreas is not functioning, such as those with Type 1 diabetes.
The transplant involved flying Porfirio’s shattered pancreas from an operating room at Walter Reed Army Medical Hospital in Washington, D.C., to Ricordi’s laboratory, more than 1,000 miles away, at the University of Miami’s Miller School of Medicine. There, the organ’s delicate islet cells were extracted and purified.
Then the stew of islet cells was sent back to Walter Reed, where -- under the remote supervision of Ricordi’s team in Coral Gables, Fla. -- physicians fed the cells through a tube into the airman’s liver.
Within days of the procedure, Porfirio’s islet cells began to produce insulin, effectively doing the work of the excised pancreas.
Porfirio is unusual also in that his islet cells came from his own pancreas, which was not dead yet. Most patients must rely on a deceased donor’s pancreas and must take anti-rejection drugs to ensure their immune system doesn’t attack the foreign cells.
The remote transplant, Ricordi said in an interview, is a first: It could mean that patients whose pancreas is destroyed by diabetes or trauma can be treated, potentially, anywhere in the country.
