WASHINGTON — In an apparent medical first, doctors removed a bullet-scarred pancreas from a wounded serviceman, flew the organ from Walter Reed Army Medical Center to the University of Miami, salvaged insulin-producing cells, then flew them back and transplanted the cells into the man's liver.
Tuesday, three weeks after the procedure, a jubilant surgical team announced that the transplanted cells are producing insulin. And Airman Tre F. Porfirio, 21, of St. Marys, Ga., felt good enough to meet the University of Miami surgeon whose team spent six, predawn hours on Thanksgiving Day isolating the cells from the ravaged pancreas.
"It's an operation we would have done for anyone, but for someone who is putting his life on the line … I couldn't think of a better way to spend Thanksgiving," said Dr. Camillo Ricordi, chief of the UM Medical School's Diabetes Research Institute, who developed the method for isolating cells from the pancreas.
The procedure represents the first known case of transplanting insulin-producing cells after a severe trauma — and the first time such a transplant has been conducted remotely, in an emergency situation.
Ricordi said he hopes it can lead to near-permanent cures for people facing diabetes — which Porfirio would have faced without a functioning pancreas.
"This could become an unlimited cure available for everyone," Ricordi said, noting that the procedure could lead to more cases of transplanting cells from even a segment of a damaged pancreas.
Doctors were working against the clock when Porfirio reached Walter Reed days after the Nov. 21 attack that gravely wounded him. He had been shot in the back by an insurgent in a remote area of Afghanistan, and surgeons there had removed parts of his pancreas, stomach, gallbladder and his entire small intestine.
Doctors had planned to rebuild his abdominal structure, but Dr. Craig Shriver, the hospital's chief of general surgery, realized Porfirio's pancreas was damaged beyond repair and pancreatic enzymes were leaking into his body, posing a threat.
Removal of the pancreas can result in a severe, life-threatening form of diabetes, which Shriver hoped to prevent. He asked transplant surgeon Rahul Jindal about alternatives. Familiar with Ricordi's work, Jindal called him.
"The answer was, 'Tell us what we can do to help,' " Shriver said.
At Walter Reed, surgeons removed what was left of Porfirio's pancreas, packed it into a container to hold it at 32.3 degrees and had it shipped via a commercial flight to Miami. Ricordi and his team received the organ at 11 p.m. and spent the next six hours removing the insulin-producing "islet'' cells.
Using enzymes and gentle heat, they extracted thousands of cells, which range from 0.002 inches to 0.02 inches, put them in a plastic bag similar to those used in blood donations, and placed the bag in the container, this time kept at 46 degrees. By 6:30 a.m., more than 220,000 purified islets were winging back to Walter Reed.
There, doctors hoisted the bag on a pole and, using gravity, fed the cells into a duct in the airman's liver, with Ricordi and team coordinating the procedure via the Internet.
Nearly three weeks later, the cells in Porfirio's liver are producing insulin, though doctors are providing extra insulin to avoid stressing the new cells.
"The cells are lodged in his liver now, and they will develop their own new blood vessels there within weeks," Ricordi says.
Ricordi is optimistic about Porfirio's prognosis, even long-term.
"There's no reason to think they (the cells) will fail at any time. He has a very good chance for long-term health."
While Porfirio's case is the first with a traumatic injury, the procedure for transplanting cells was developed by Ricordi and colleagues in 1990. It's used mostly in worst-case patients, often those with Type 1 diabetes, in which the pancreas produces no insulin.
But in such cases, the cells are extracted from cadaver donors, meaning recipients must take powerful antirejection drugs, as if they'd had a full organ transplant.
In recent years, however, increasingly sophisticated anti-rejection drugs are prolonging the lives of the transplanted cells, Ricordi said.
"In the past five years, we're seeing tremendous progress," Ricordi said. "In the most recent trials, 70 percent of patients were showing success at five years — the same as with an organ transplant."
His doctors say Porfirio — who has had 11 surgeries in the 20 days he has been at Walter Reed — is mending well. The patient got to visit with Ricordi on Tuesday, and Ricordi, who speaks with a thick Italian accent and attended medical school in Milan, noticed a tattoo on the airman: "Italia."
Porfirio's father, Karl, who talked to the surgeons by phone from St. Marys, just north of Jacksonville, told the surgeon that the family hails from the Abruzzi region of Italy.
"I can't thank you enough for saving my son's life," Karl Porfirio said to the surgeons. "I'm just overwhelmed."