Six days before Thanksgiving, a 21-year-old Air Force enlistee, 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 we need to extract fuel from the food we eat.
With an injury like that, Porfirio's prognosis was very 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.
But doctors who improvised a way to help the serviceman quickly made Porfirio a pioneer in the technique of islet-cell transplantation instead.
On Tuesday, Dr. Camillo Ricordi, director of the University of Miami's Diabetes Research Institute, told the story of a long-distance islet cell transplant — a still-experimental procedure considered to be the best hope for treating those, such as Type 1 diabetes patients, with a non-functioning pancreas. The transplant involved flying Porfirio's shattered pancreas — now removed — from an operating room at Walter Reed Army Medical Hospital in Washington to Ricordi's specialized laboratory, more than 1,000 miles away, at the University of Miami's Miller School of Medicine. There, on the night before Thanksgiving, the delicate islet cells of Porfirio's own pancreas were extracted and purified — a specialized operation performed at only a handful of transplant centers across the country.
Until now, if you were a patient who couldn't make it in time to one of 15 cities with medical centers equipped to prepare islet cells for transplant, you were out of luck. But physicians willing to try anything to help Porforio have shown that may no longer be true.
The stew of islet cells prepared at the University of Miami was sent back to Walter Reed. There — under the supervision of Ricordi's team in Coral Gables, Fla., watching remotely — physicians carefully fed the purified cells through a tube into the airman's liver. Within days of the procedure, performed on Thanksgiving, Porfirio's islet cells did what all physicians hope they will do in such cases: They 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, while in shreds, 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 ability to use Porfirio's own islet cells for the transplant, while "very rare," according to Ricordi, means he will not face rejection issues that make such transplants a lifelong challenge for recipients.
That remote transplant, said Ricordi in an interview, is a first: it could mean patients whose pancreas is destroyed by diabetes or trauma can be treated, potentially, anywhere in the country. Having shown that islet cells can be prepared for transplantation remotely and returned in time to a waiting patient — and then, that physicians with minimal training in such transplants can be supervised in doing them — Ricordi's team says that many more patients may gain access to the procedure. Patients with chronic pancreatitis, an inflammation of the insulin-producing organ, may, with some fancy logistics, be able to get the treatment they need close to home. And patients whose pancreas is compromised or destroyed by trauma can be treated where they are.
— Melissa Healy