Posted: 10th September 2019
When Dr Tom Loudovaris embarks upon a human islet isolation for transplantation, there is a lot at stake.
The process begins when Tom and his team receive delivery of an esky. Sitting on ice inside it lies a precious cargo: a pancreas that has been removed from an organ donor. The organ is ready to have its major components separated by Tom and his team, while a recipient with type 1 diabetes remains on standby to receive the resulting insulin-producing islets. This treatment generally frees the recipient from dependence on insulin injections.
But on the 25th of July, 2019 even more was a stake.
Tom received an esky that contained the pancreas of eight-year-old Perth resident, Hayley Minson-Rivers. Hayley had been in and out of hospital her entire life due to the complications of chronic pancreatitis.
"I was having lots of pain and attacks with my pancreas. It stopped me from [going to] school," she said.
"I like to run around and [go] swimming but it was hard before because my tummy would get sore."1
Hayley is one of the several hundred Australian children who live with hereditary pancreatitis, and one of the first to receive a treatment known as a pancreatectomy islet auto-transplant.
Hayley’s pancreas was removed at the Women's and Children's Hospital in Adelaide during a painstaking 6-hour surgery. Her pancreas was then bagged, placed in an esky and put on a plane to Melbourne.
When the package arrived at SVI around 2pm, Tom and his team got started on the 4-hour islet isolation procedure, which is performed under the strictest germ-free conditions in specially designed containment hoods within SVI’s Susan Alberti Islet Isolation Facility.
After thorough decontamination and trimming, Tom positioned a thin, flexible tube in the pancreatic duct, placed the tissue in a tray and a team member carefully injected an enzyme into it. Keeping the tissue and surroundings at 4 degrees, Tom dissected the pancreas into 1-2 cm pieces and transferred it to a special chamber containing a special mesh.
He increased the temperature of the chamber to 37 degrees, at which point the enzyme became active and started to digest the tissue. After 30 minutes, the pancreas had broken down into pieces that could pass through the mesh and the precious cells were collected and washed.
Through this process, Hayley’s 50g pancreas was reduced to a 100ml suspension of tissue and transferred to an infusion bag. The suspension was tested to make sure it was healthy and safe to be infused back into Hayley.
The cells were then flown back to Adelaide, with the clock ticking as the team rushed so they could get the special delivery on the last commercial flight of the day. Back in Adelaide, the bag was attached to a tube that infused the cells into the portal vein of Hayley’s liver, some 12 hours after the surgery first began. There the islets lodged in their new home and within a short amount of time began producing the insulin required to keep Hayley’s blood sugar levels within the normal limits.
The Susan Alberti Islet Isolation Facility is one of only two places in Australia where the islet isolation procedure can be undertaken for transplantation, and there are few surgical teams who are able to carry out the complicated surgery.
Prior to the procedure being available, the only treatment available for patients with chronic pancreatitis was total removal of the pancreas, which made the patient reliant on insulin injections and digestive enzyme replacement for the rest of their life.
The team are now working to make it available to more patients, by increasing the locations at which the surgery can be carried out, and training and equipping other labs in Australia to carry out islet isolation.
Tom says that while the team pays utmost care and attention to every islet isolation they do, the isolations carried out for kids with pancreatitis have higher stakes.
“These cells we isolate are precious because we only get one go at this – there really is a lot at stake. For me personally, my son has type 1 diabetes, and I know what it means to live every day walking the tightrope of managing your own insulin levels. Being part of the team that works to ensure these kids avoid having to live with type 1 diabetes is hugely rewarding.”
About hereditary pancreatitis
Hereditary pancreatitis is a genetic condition which causes recurrent episodes of inflammation of the pancreas. The pancreas produces enzymes that help digest food and insulin, a hormone that controls blood sugar levels in the body. Hereditary pancreatitis can lead to permanent tissue damage and loss of pancreatic function. Until recently, the only treatment available for extreme cases was removal of the entire pancreas, which results in onset of diabetes and a dependence on insulin, due to loss of the islets containing the insulin-producing cells as well as their counter-regulatory cells containing glucagon and somatostatin.
1 These quotes originally appear in an ABC article which appeared online on 3 September 2019.