Doctors perform groundbreaking surgery at Walter Reed

  • Published
  • By Kristin Ellis
  • Staff writer for Stripe
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.

While serving with an Army unit in Afghanistan, 21-year-old 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. Seventy-two hours and 8,000 miles later, Airman 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.

Airman Porfirio's commander at Wright-Patt, Lt. Col. Rick Johns, said despite the severity of his injuries, the Airman is in great spirits.

Immediately after Airman Porfirio arrived at Walter Reed, Air Force officials arranged for his father Karl and a brother to be flown to his bedside. Colonel Johns then joined Airman Porfirio's best friend, Senior Airman Scott Cross, to visit and encourage him, bringing along the well wishes and prayers of the entire 88th Communications Group.

Colonel Johns said the charitable Luke's Wings organization is helping provide transportation for Airman Porfirio's dad, three brothers and girlfriend to be with him for the Christmas holiday.

"It's absolutely a miracle that he's alive and making this rapid progress," Colonel Johns said. "(Airman Porfirio) is understandably a little tired of being poked and prodded, but he's a fighter. It was incredible to see him stand.

"I know Airman Porfirio has been touched by the outpouring of support from his extended Air Force family," the colonel said.

Recently the St. Marys, Ga. native took his first steps since being wounded. Colonel Johns said doctors have acknowledged the Airman's level of fitness has contributed to his remarkable recovery.

"I do believe the Air Force's (physical training) program played a major role in saving his life," Colonel Johns said, noting all of the Airmen in his unit deploy and on any given day about a third are down range supporting joint warfighters. The squadron's regular group runs, aerobic and strength conditioning contribute to both camaraderie and the physical rigors of deployment, he added.

At Wright-Patterson AFB, Airman Porfirio's job is to help maintain the Air Force's largest telephone switching network with more than 26,000 lines.

Officials hope to be able to transfer Airman Porfirio in the next several months from Walter Reed to the Wright-Patterson Medical Center where he will continue his recovery.

(Courtesy of American Forces Press Service. Derek Kaufman from the 88th Air Base Wing Public Affairs Office contributed to this story)