Major Milestone: 1,000 Kidney-Pancreas Transplants
MADISON - In the beginning, doctors called the pancreas "The Beast" and struggled to find a way to solve the post-transplant problems that so frequently led to infections and patient death.
Now, 40 years after the first successful pancreas transplant, Hans Sollinger, MD (pictured) and the Transplant Program at University of Wisconsin Hospital and Clinics have become the first to reach an impressive milestone in organ transplantation: 1,000 simultaneous kidney-pancreas transplants.
Clearly a cause for celebration, correct?
"To be honest, the reaction here was somewhat surprising," says Sollinger, the UW Health surgeon who heads the second largest kidney-transplant program in the United States, "because Wisconsin came late to the pancreas party."
Sollinger's first successful pancreas transplant occurred in 1983. It's number 32 on the national registry, well behind the University of Minnesota, the program that performed the first one in 1967. In the intervening four decades, however, things have changed rather dramatically.
"Because we were successful with our surgical technique, a lot of patients came to us," says Sollinger. "We always had a great Organ Procurement Organization, and before we knew it, we passed the rest of the world. And we also had the best results."
According to data published in July 2008 by the Scientific Registry of Transplant Recipients (SRTR), the UW Transplant program's one-year kidney transplant graft survival rate for simultaneous pancreas-kidney transplants was 95.39 percent, and the one-year pancreas graft survival rate for simultaneous pancreas-kidney transplants was 88.48 percent.
Both survival rates are deemed higher than expected by the SRTR based upon patient demographics and the experience of similar patients in the entire country.
Each year, surgeons at UW Hospital and Clinics perform between 35 and 55 simultaneous kidney-pancreas transplants. SPK transplants are done on patients with kidney disease caused by Type 1 diabetes.
It certainly wasn't always this way. Early surgical attempts in the 1960s to transplant the pancreas, the organ that produces insulin, the substance that allows the cells to absorb and use energy, were thwarted by the pancreas's digestive juices. The excretions often drained into surrounding organs and created serious and sometimes deadly infections.
"When I started on the faculty here in 1980, I asked Dr. Folkert Belzer, who headed the program at that time, if I could start a pancreas program, but he was dead set against it," Sollinger recalls. "He felt the complication rate was too high - 40 percent of patients died within the first year - and unless I came up with something better, he wouldn't allow me to do it."
So Sollinger came up with something better. The Austrian-born surgeon came up with the idea to channel the pancreas secretions into the bladder, a notion that would come to be known as the Wisconsin Technique and would transform the world of pancreas transplant.
After his first pancreas transplant in 1983, Sollinger performed his first series of combined kidney pancreas transplants in 1985. His work with pancreas transplantation eventually benefited from the creation of UW Solution, the organ preservation solution that extended the life and usefulness of recovered donor organs.
Over the last several decades, more than just surgical technique has evolved. In the 1980s, patients stayed in the hospital for three weeks after their surgery, and had to return for follow-up care five to six times a year; today, they typically go home in less than a week and only come back only three or four times a year.
New anti-rejection drugs with fewer side effects and antibody-reduction techniques have opened the possibility of transplant to an even greater number of patients.
Today, the University of Wisconsin is one of the only transplant programs in the country with extensive 20-year patient survival data. This coming April, Sollinger will present the data he's collected over the course of his program's storied history at the annual meeting of the American Surgical Association.
But while he'll appreciate the respect he'll surely receive from the medical community, it's the patients whose lives he's changed who remain on his mind as he contemplates what his program has achieved.
"We transplanted people from 25 different states, patients who went on to have children and resume their lives and professions," says Sollinger. "We've done a lot of good."
Type 1 diabetes is the reason patients require a pancreas-kidney transplant. In patients with Type 1 diabetes, the pancreas fails to produce adequate amounts of insulin. Undigested sugars instead remain in the patients' bloodstream, damaging key organs like the kidneys. Eventually, many diabetics require blood-cleansing dialysis sessions just to stay alive.
According to Sollinger, diabetic patients have only a 25 percent chance of surviving after five years on dialysis and only a 5 percent chance of surviving 10 years on dialysis. Their chances soar to 80 percent with a simultaneous or combined kidneypancreas transplant, and 65 to 70 percent of them stand an excellent chance of surviving several decades with a successful transplant.
"In many cases, patients who undergo a pancreas-kidney transplant find their blood sugars return to within 5 percent of normal following surgery," notes Sollinger. "This surgery has the power to transform people's lives."