UToledo Health has expanded its organ transplantation program to include pancreas transplants, building on the University of Toledo Medical Center’s long history as a premier kidney transplant center.
UTMC, which is northwest Ohio’s only organ transplantation center, received approval to perform pancreas transplants in December and completed its first procedure in February.
Dr. Kunal Yadav, a UToledo Health transplant surgeon and director of the new pancreas transplant program, right, performed Taylor Iceman’s successful surgery kidney and pancreas transplant surgery at UTMC last month.
“We are proud to expand our transplantation program and provide another life-saving treatment opportunity to our patients,” said Dr. Charles “Chuck” Callahan, executive vice president for health affairs. “UToledo Health has earned national recognition for our kidney transplant program. Adding pancreas transplantation is a natural next step that builds on that expertise and expands the scope of specialized care we’re able to offer right here in Toledo.”
Pancreas transplants are most commonly done in patients with Type 1 diabetes. While sometimes done alone, pancreas transplants are far more often performed alongside a kidney transplant in patients with kidney failure brought on by insulin-dependent diabetes.
That was the case for Taylor Iceman, who received a kidney and pancreas transplant at UTMC last month.
Iceman, who lives near Mansfield, was diagnosed with Type 1 diabetes as a teenager. After living with the disease for nearly 25 years, his kidney function had decreased to the point that he needed a new kidney. His doctors suggested he consider a simultaneous kidney-pancreas transplant, which would address not only his kidney disease but also cure his diabetes.
The pancreas, a tadpole-shaped organ located in the upper left part of the abdomen, plays important roles in digestion and regulating blood sugars.
In Type 1 diabetes, an individual’s pancreas produces little or no insulin. Over time, diabetes can cause damage to blood vessels and other structures in the kidneys that are critical for filtering waste from the body.
“When we do a kidney transplant only in those patients, we’re not treating the disease that caused the damage in the first place,” said Dr. Kunal Yadav, a UToledo Health transplant surgeon and director of the new pancreas transplant program. “If we’re able to also give them a new pancreas, we’re curing their diabetes along with restoring kidney function. For a lot of patients, this is the best option.”
Iceman was initially evaluated for the transplant by a Cleveland-area hospital. After a year on that hospital’s wait list, he followed up on a recommendation from his nephrologist that he look into getting listed at UTMC, which was preparing to launch its own pancreas transplant program.
The 39-year-old underwent testing in October and was officially listed for a transplant at UTMC in January. Just a few weeks later, on Feb. 12, he underwent a successful transplant.
“When I woke up in the hospital, I was sore but I felt better,” Iceman said. “My wife and people who saw me said my color was so much better already, just automatically.”
As a father of three who had continued working full time as a high school athletic director and basketball coach throughout his battle with kidney disease, Iceman kept a fast-paced schedule.
Though he was able to do dialysis at home while he slept, his illness zapped him of his energy. Most nights, he said, he’d fall asleep on the couch after work.
“Being on dialysis is tough. It was something I had to do, but it was starting to wear on me,” he said. “I’m really glad to be where I’m at now. Everything’s been great, all the people who helped me. I’d go up there and tell them all hi and thank them again if I could. I’ve had nothing but a great experience and definitely would recommend people to come here.”
Yadav, who performed Iceman’s surgery, said the procedure went well and he is recovering nicely.
“He’s doing great,” Yadav said. “His kidney function has been excellent. He did not need any dialysis after transplant. His pancreas worked straight away also. Right when we were in the operating room, we stopped giving him insulin and he has not needed any since. He’s had a great outcome.”
UToledo Health already is a leader in kidney transplants, with UTMC having performed them for more than 50 years. Kidney transplant volumes at UTMC have grown significantly over the last five years and the hospital’s program has consistently had the fastest wait list in the country.
According to the most recent report from the Scientific Registry of Transplant Recipients, the median time patients spend from being listed to receiving a kidney transplant at UTMC is less than two months. That compares to a national average of nearly two and a half years.
The Scientific Registry of Transplant Recipients also reported patients transplanted at UTMC have a 90-day kidney survival rate above the national average.
Like any organ transplant, pancreas transplantation is a major surgery, and patients must take immunosuppressant drugs to prevent rejection of the new organ for the rest of their lives.
Because of those risks, transplant is not a first-line treatment for most patients with diabetes. However, in diabetic patients who need a kidney transplant, including some with Type 2 diabetes, the calculus changes.
“You’re going to give immunosuppression and antirejection medications to those patients already,” Yadav said. “It’s not an additional surgery. They’re not going to need any additional medications, and often they’ll need less long-term medication because they don’t need to take insulin after the transplant. It can be a life-changing procedure.”
Kidneys are by far the most commonly transplanted organ globally, with nearly 27,000 procedures performed in the U.S. last year. Simultaneous pancreas-kidney transplants, by comparison, are relatively rare. Over the last five years, U.S. transplant centers have averaged around 850 cases annually.
Part of the reason, Yadav said, is that Type 1 diabetics make up a relatively small portion of the overall kidney transplant patient pool. Patients also must meet certain criteria, including age, body mass index and overall health, to receive a pancreas transplant.
Standalone pancreas transplants are rarer, with only about 120 been having been done in the U.S. in each of the last three years.
However, UToledo Health officials say there is a need for new programs, particularly in this part of the country. Last year, just seven pancreas transplants were done in the state of Michigan.
“This is an area where we feel we can make a real difference, in our backyard and across our region,” said Dan Barbee, UTMC chief executive officer. “There is a need for improved access to pancreas transplant. We’re well-positioned to provide this service and to do so at a very high level.”
For Iceman, who is looking forward to no longer needing insulin shots with every meal and the freedom and energy to do more with his family, the main side effect immediately post-surgery has been boredom. His normally busy days have been replaced with daytime TV as he recovers.
“I’m ready to get back to doing some things,” Iceman said.
