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December 15th, 2009
05:49 PM ET

Landmark trauma surgery was a collaborative effort

By Val Willingham
CNN Medical Producer

On November 21, Senior Airman Tre Porfirio was struck in the gut by three high velocity bullets while serving in Afghanistan. Porfirio, from St. Mary's, Georgia, was seriously injured; his entire digestive system was in danger of shutting down. During two operations in combat hospitals, surgeons removed his gallbladder along with portions of his large and small intestines, part of his stomach and a large section of his pancreas.
Porfirio was flown back to the United States immediately after emergency surgery, and taken to Walter Reed Army Medical Center, in Washington, D.C.

Col. Craig Shriver, chief of general surgery at Walter Reed, knew he had to remove the airman's remaining pancreas, which was found to be damaged beyond repair. "The optimal procedure at this point was to remove his entire remaining pancreas to prevent further leakage of the pancreatic enzymes and control the bleeding, which could be fatal," said Shriver. "We knew that the procedure would lead to the most severe and life-threatening form of diabetes, which tends to be very brittle and difficult to control in this type of situation.”

In an effort to save Porfirio from severe diabetes, Shriver turned to other surgeons for suggestions. Dr. Rahul Jindal, a transplant surgeon also at Walter Reed, had training and experience in islet cell transplantation, which is considered the best hope for curing diabetes. In islet cell transplantation, the insulin-producing islets are taken from a donor pancreas, treated and then put in the patient's liver where they begin to produce insulin for the body, even if there is no pancreas. In this case, the islet cells would come from Porfirio's own pancreas.

"Isolation and purification of pancreatic islets is a very intricate procedure, which requires a specialized laboratory, and there are only a few such facilities in the United States," said Jindal.

But Jindal knew of the perfect facility for the job; he turned for help to the Diabetes Research Institute at the University of Miami Miller School of Medicine. The director of the institute, Dr. Camillio Ricordi, developed the method for isolating the islet cells from the pancreas and was considered a pioneer in the field. Ricordi immediately agreed to help, noting that he would do "anything to help a wounded warrior."

Doctors at Walter Reed then proceeded to remove the remaining portion of Porfirio’s pancreas, packed it in ice and sent it to Miami.

On Thanksgiving Day, just five days after Porfirio's initial injury, the cell processing team at the Diabetes Research Institute spent six hours performing the islet cell isolation and purification procedure. "More than 220,000 purified islets were then suspended in a specialized cold solution and flown back to Walter Reed,” said Ricordi.

That afternoon, on that very same Thanksgiving Day, the islet cells were injected into Porfirio’s liver with Ricordi and his team coordinating the procedure with surgeons at Walter Reed via an Internet connection, a sort of high-tech telemedicine event.

In the three weeks since being wounded in Afghanistan, Porfirio has undergone 11 surgeries and, according to doctors, is "doing well." In a press conference held Tuesday at Walter Reed Medical Center, surgeons noted that there was evidence of the airman’s islet cells functioning in his liver less than one week after surgery; 15 days after the procedure, the transplanted islet cells were functioning in the normal range. His physicians say as time goes on, the islet cells in the liver will get stronger; when that happens, Porfirio's insulin requirement is expected to decrease. And although he'll still have a form of diabetes, the complication won't be as dangerous and he'll have a better quality of life.

Doctors from both the University of Miami Miller School of Medicine and surgeons at Walter Reed believe this transplantation is the first of its kind in a wounded soldier. They hope the success of the procedure will allow for more cases of islet cell transplantation in military personnel, as more of our fighting men and women return from war with injuries like those of Senior Airman Porfirio.


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soundoff (270 Responses)
  1. Chris

    Amazing! Best wishes to Airman Porfirio for a speedy recovery

    December 16, 2009 at 01:26 | Report abuse | Reply
  2. Valerie

    My Mother is a diabetic and a leap in science that helps increase the quality of life of diabetics is good. I laude the efforts of both groups of doctors at Walter Reed and the University of Miami Miller School of Medicine. Great work! As a military veteran, myself, I would like to thank SrA Porfirio for his sevice. Good luck on the road to recovery!

    December 16, 2009 at 07:16 | Report abuse | Reply
  3. Shawn

    ...and people say military medicine is not worth its weight. Ha! This is absolutely outstanding!

    I keep you in my thoughts SrA Porfirio; you're a testament to the strong will that our Airman, much less all our folks in the Armed Services, to succeed in the face of adversity. May your recovery be swift!

    Sgt. E

    December 16, 2009 at 09:49 | Report abuse | Reply
  4. Dave

    Hey Tre, thanks for serving man. You are a hero and I am glad to hear you are doing well. Hang in there man, we are all pulling for you.

    December 16, 2009 at 11:59 | Report abuse | Reply
  5. Yahbut

    Wow! What an amazing story!

    I didn't think people could live without a pancreas.

    Now this is the kind of news I'd like to hear more about.

    Congratulations to all the doctors and other medical personnel involved.

    This is what the United States is all about. This is the type of story that makes me so proud of our country.

    My thanks to the serviceman for what he has given for freedom. We will always owe him a debt of gratitude.

    Thanks to all of you for making this a happy day for me.

    December 16, 2009 at 12:10 | Report abuse | Reply
  6. Molly

    This is amazing. I thought the body normally couldn't function without the pancreas. I'm wondering if we're seeing a sneak peek at future treatment for diabetes and maybe even pancreatic cancer. Bravo!

    December 16, 2009 at 13:18 | Report abuse | Reply
  7. ERIKA

    This is awesome news. Kudos to the medical team and swift healing to the Wounded Warrior.

    December 16, 2009 at 14:43 | Report abuse | Reply
  8. John Ryan MD FRCS FACS

    Excellent work by talented people and a wonderful logistical system.
    Full marks to all concerned.

    John Ryan
    Professor.Sanford S

    December 16, 2009 at 20:01 | Report abuse | Reply
  9. AllenB

    This is the way our military members and veterans should be treated. Nothing but the best and all obstacles removed. Great job all involved.

    December 17, 2009 at 01:18 | Report abuse | Reply
  10. Jeannette Vance

    What an amazing process. I pray SRA Porfirio continues to get better.

    December 17, 2009 at 10:54 | Report abuse | Reply
  11. avenuto

    pretty amazing medicine

    December 17, 2009 at 11:12 | Report abuse | Reply
  12. SSgt Corey

    It is so great to hear about the advances in medical science that allows doctors to heal our fellow service members. My hope is that SrA Porfirio can return to service if he desires.

    December 17, 2009 at 14:07 | Report abuse | Reply
  13. David Hornsby

    Just wanted to say thank you to all the Doctors that helped Tre out. I was stationed with him in Afghanistan when this all happen. He's a good and strong soldier. My prayers are to him and his family. I pray for a full recovery. Take care Tre!!!

    SSgt Hornsby

    December 17, 2009 at 15:15 | Report abuse | Reply
  14. Andy hoffman

    Amazing. I hope this can become the norm for people who lose their pancreas!!

    – A

    December 18, 2009 at 07:20 | Report abuse | Reply
  15. Esky

    I can't imagine what kind of courage it must have taken Tre to fight his way through this severe wound. Proud to serve alongside young Americans like him. /salute

    Sgt. EP

    December 18, 2009 at 13:52 | Report abuse | Reply
  16. Claudia Halpain

    This is an amazing story and I want to wish Sr. Airman Porfirio a speedy recovery and I want to wish him and his family a Healthy and Happy New Year!!!!!!!!!!!

    December 18, 2009 at 15:46 | Report abuse | Reply
  17. CSM(r) Tom Detchemendy

    HO AH. Way to go. Kudos to all involved including the patient. You all could have been home with your families and put this off until later. I am humbled and I salute you for taking care of one of my 'soldiers'.
    SMAJ

    December 18, 2009 at 15:47 | Report abuse | Reply
  18. Okechukwu Nnaeto

    The US and their science will never stop to stop to amaze me. What a wonderful procedure! Kudos to all that were involed.

    December 24, 2009 at 02:06 | Report abuse | Reply
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    WOW!!!
    God bless those doctors!

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.