Transplants cure kidney failure, type 1 diabetes

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by Sandra Jordan

(NNPA)—Nathan Brass of St. Louis gets up early to get in his exercise before class at Florissant Valley Community College, where he is studying to be a dietician.

Nutrition is important to him, because it is an important element to overall good health and one way he can give back to others. Brass knows about giving because he has been given a lot—almost four years ago he received a new kidney and pancreas from the same donor.

Brass was diagnosed at age nine with type 1 (juvenile) diabetes, which meant his pancreas did not produce insulin and he was dependent upon insulin injections to survive. In 1999, he developed renal failure as a result of the diabetes, and went on the kidney transplant waiting list.

“My mom was a match for a kidney, so basically they told me either I could get a kidney from her and I’d still have diabetes or I could wait and get a kidney and a pancreas,” Brass said.

A kidney and pancreas transplant would remove the need for insulin injections and for kidney dialysis.

Brass decided to wait it out.

It was Easter Sunday, April 16, 2006 when he received his combined transplant.

“Immediately after the surgery, I really said to myself, ‘What did I do?’ because I was just in some serious pain. And then after a couple of days, I started to feel a little bit better,” Brass said. “I got up and sat in a chair and then after a couple of days, I felt stronger and started walking around the hospital and doing a little physical therapy to get back in order.”

Being hooked up to so much medical equipment, he initially didn’t notice that he was no longer dependent on insulin.

“My blood sugars were pretty regular. The pancreas really went in to work,” Brass said. “I think one of the highest blood sugars I had was probably like 120 when I was in the hospital and then after that, they all pretty much stayed at 100 or below 100.”

He was in the hospital seven days.

After taking it easy for 90 days like the doctor told him, Brass joined the Emerson YMCA to further his recovery.

“I started doing a little strength training and cardio work and slowly it started to pick up and it got better and better and I got stronger and I got my weight back and right now I’m doing pretty good,” Brass said.

Barnes-Jewish Hospital has seen more than an 80 percent increase in its volume of pancreas transplants, said Dr. Jason Wellen, director of kidney and pancreatic transplantation at Barnes and associate professor of surgery at Washington University School of Medicine. He attributes the increase in transplants in part to awareness and education initiatives for patients and physicians in the community by the Juvenile Diabetes Research Foundation.

“About 90 percent of all pancreas transplants are done for patients who have type 1 diabetes who have ultimately developed renal failure or are in the process of ending up on dialysis,” Wellen said. “It is really the only treatment presently that provides the opportunity for patients to be rid of their diabetes in the sense that every patient that we’ve have transplanted in the past year has not required a single unit of insulin from the time their pancreas has gone in.”

That means going from checking blood sugars four to six times a day and watching every morsel of food and drink ingested to “regular” eating, no blood sugar finger pricks and no insulin injections.

“It improves that five year survival to well above 80 percent. The main reason for that is because you’ve made their blood sugars completely normal with the pancreas and the diabetes does not attack that new kidney transplant,” Wellen said. “It significantly improves the patient’s quality of life in the sense that the patient’s sugars are completely normal despite whatever diet they eat and it’s actually been shown to reverse some of the secondary complications of diabetes.”

Wellen said it eventually reverses neuropathy—the tingling or numbness in the fingers and toes and studies have shown it also halts the progression of visual impairment.

However, Wellen said a pancreas transplant is not a solution for type 2 diabetes, which is a serious problem within the African-American community.

“Type 2 diabetics still make normal amounts of insulin, the problem is that due to their obesity (usually the cause of type 2 diabetes) the receptors throughout the body that are supposed to recognize insulin, do not. Therefore, providing a type 2 with a pancreas that will only give them more insulin won’t help them,” Wellen explained.

“However, type 2 diabetics that develop renal failure definitely benefit from a kidney transplant.”

Patients with pancreatic cancer cannot benefit from a pancreas transplant either because of the immunosuppression medication (to prevent rejection of the transplant) would make the cancer grow out of control.

“If you have cancer within two years, you are not a candidate for kidney or pancreas transplant because you are not going to get immunosuppression and ramp down your immune system and you need your immune system to fight cancer,” Wellen said.

For more information, go to http://www.barnesjewish.org/transplant/kidney_pancreas or http://www.jdrfstl.org.

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