Rare Pancreas Removal and Islet Cell Transplant Enable Man to Eat Again Without Developing Severe Diabetes

For immediate release: October 31, 2001


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For two years, Jonas Stoltzfus could not sit at the dinner table with his family to eat a meal. Whenever Stoltzfus ate, his pancreas became severely inflamed, and his stomach knotted up in extreme pain, the result of severe, chronic pancreatitis. The 35-year-old Amish man from Lancaster, Pennsylvania was kept alive only with intravenous nutrition therapy. Today, following the removal of his pancreas and a rare autologous islet cell transplant, Stoltzfus can eat and drink again.

His case was so severe he couldn't eat or drink at all. He was getting IV nutrition but was developing infections from catheters. He kept losing weight, and probably would have died, says Alan Farney, M.D., Ph.D., transplant surgeon and director of the Islet Transplant Program at the University of Maryland Medical Center. Dr. Farney is also an assistant professor of surgery and pediatrics at the University of Maryland School of Medicine.

Stoltzfus began IV nutrition therapy in August of 1999. Prior to that, he endured frequent, painful pancreatitis attacks and was repeatedly admitted into the hospital. Numerous procedures and operations failed to solve the problem.

But the removal of his pancreas, along with an islet cell transplant at the University of Maryland Medical Center, has changed Stoltzfus's life. The 14-hour surgical procedure, performed on June 26, is believed to be the first successful autologous islet cell transplant in Maryland in more than 20 years.

Dr. Farney and colleague Benjamin Philosphe, M.D., Ph.D., also a University of Maryland transplant surgeon and assistant professor of surgery, removed Stoltzfus's pancreas and processed the organ so that in its dissolved form it could be re-infused into his liver. The islet cells from his pancreas began to make insulin right away. Since the procedure, Stoltzfus has been able to eat without any pain. And because of the islet cell transplant, he is not expected to become severely diabetic, even without his pancreas. It's made a dramatic change in his quality of life, says Dr. Farney.

The only curative treatment for severe pancreatitis is a pancreatectomy the removal of the pancreas. However, if Stoltzfus had this operation without an islet cell transplant, he would have developed a rare form of diabetes called surgical diabetes. His blood sugar levels probably would have been difficult to control, even with taking insulin, putting him at risk for serious complications of diabetes, such as kidney failure, heart disease and blindness.

Stoltzfus started taking insulin injections as a precaution following his operation, but he stopped in mid-September. Since then, Kristi Silver, M.D., associate medical director of the University of Maryland's Joslin Diabetes Center and an assistant professor of medicine at the University of Maryland School of Medicine, has been measuring Stoltzfus's blood sugar levels to determine if he should resume taking insulin.

Right now, Mr. Stoltzfus doesn't need to be on insulin. Based on his home blood sugar readings and the results of an oral glucose tolerance test, we know his islet cells are making insulin. While his blood sugar levels aren't perfectly normal, they are much better than they would have been without the transplant. His progress is definitely impressive, says Dr. Silver.

There are two kinds of islet cell transplants. Stoltzfus had an autologous islet cell transplant, which is a rare procedure performed on people with pancreatitis who are not diabetic. With this kind of transplant, the pancreas is removed, and then the patient's own islet cells are transplanted into the liver. That is intended to prevent the patient from becoming severely diabetic after the pancreas is removed.

In contrast, an allogeneic islet cell transplant is performed on patients with Type I diabetes. In this procedure, which is much less involved because the pancreas is not removed, donor islet cells are injected into the patient. This kind of transplant can be done repeatedly, because doctors can use cells from several donated pancreases. However, these patients must take medication following the transplant to prevent rejection.

Stoltzfus, who had been receiving care at Hershey Medical Center in Pennsylvania, came to the University of Maryland Medical Center after speaking with a friend whose daughter had suffered from pancreatitis and had received an islet cell transplant in Minnesota. Stoltzfus contacted the Minnesota surgeon, who recommended that he speak with Dr. Farney.

Only a few centers in the country have ever done this kind of transplant, and not many people are aware of it, including physicians," says Dr. Farney. Virtually all procedures of this kind previously have been done at University of Minnesota Medical School, where Dr. Farney trained before coming to Maryland.

Stoltzfus was determined to have his pancreas removed, along with the islet cell transplant. I didn't have much choice. It was either that or die, he says.

Stoltzfus, who had had a series of medical problems before developing severe pancreatitis, spent four weeks in the hospital after the transplant. Once he went home, however, he was able to eat solid food again, for the first time in two years.

And what was the first thing he ate? A soft pretzel. My wife makes really good soft pretzels. I like them when they're warm, says Stoltzfus, who can now enjoy eating meals at the dinner table again with his wife and 10 children.

Despite everything he's been through Stoltzfus says, I feel a lot better. I feel blessed.


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