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“He said, ‘Stephanie, people get thirsty,’ ” Arneson recalled. “This whole normal thing is so hard to get used to.”
The genesis of the U’s islet transplant program came in 1974, when surgeons David Sutherland and John Najarian performed the first transplant from a deceased donor to a living recipient. Decades of research followed. The University of Alberta in Edmonton achieved a major breakthrough with a protocol using multiple donors, but the recipients returned to insulin after a year or two. In 2005, the U developed a new protocol to harvest cells from a single donor and reported last year that the recipients had remained off insulin, or nearly free of it, after many years.
“So now that has become the new standard,” Hering said.
The procedure goes like this: When a donor pancreas becomes available, its islet cells are harvested and cleaned. Then they’re injected through a small incision in the recipient’s belly into a “portal” vein, which delivers them to the liver (the pancreas itself is fragile and hard to reach). They settle in and begin producing insulin. The patient then receives immunosuppressants, which keep the body from attacking the foreign cells.
Lorna Zaworski, 47, of Minneapolis, was diagnosed with diabetes at age 9. She got a transplant of islets cells at the U in August 2000 and hasn’t needed insulin in nearly 13 years. Asked to describe her life before the operation, she turned to her husband, Tom.
“I met her on the floor of the Northtown Mall,” he said. “She was one of my better customers when I was working security there.”
Tom Zaworski said Lorna had such brittle diabetes that he debated whether to marry her for five years. “She was starting to have lows behind the wheel. We nicknamed her ‘Crash’ because she crashed so many vehicles,” he recalled.
Just a month after they finally married, she was put on the transplant list at the U, and six weeks later she received her islet cells from a donor in Oregon.
Unlike some patients, Lorna Zaworski hasn’t suffered ill effects from the immunosuppressants, which can cause mouth sores, stomach problems, diarrhea, anemia and increased susceptibility to disease.
For now, islet cells must be harvested from the organs of deceased donors. But with only 7,000 pancreas donors a year, and only 2,000 to 4,000 suitable for transplant, there won’t be enough to go around. The U is at the forefront of research that could lead to a ready supply of islet cells, however, either from specially bred pigs that live in sterile pens, or from human stem cells.
Hering said he’s betting on pigs, although the idea takes some people aback. They’re easier to control for quality and consistency, he said.
Both technologies promise to eliminate the need for immunosuppressant pills and their side effects; some of the islet cells have been engineered to make insulin and other hormones, but also immunosuppressive medications.
“We have genetically engineered pigs with very unique islets,’’ Hering said. “That is a reality. That’s not just science fiction.”
Dan Browning • 612-673-4493