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ON THE WINGS OF THE FIRST UMDNJ PANCREAS/KIDNEY TRANSPLANT
Now, off dialysis, off insulin, no longer diabetic and punctuating every sentence with a string of giggles, Woredekal wonders, "Could medicine be making me so happy?" Because she is actually taking only anti-rejection medications and not mood altering drugs, Almaz knows the truth about her new life: There is no room for sadness. "I laugh all the time now. Friends and relatives are calling me the crazy lady but life is so glorious. I am able to see tomorrow." Her surgeon, James W. Lim, MD, Chief, Section of Pancreas Transplant and assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School, says, "A lot of people don’t know about the advantages of this pancreas/kidney transplant option." Almaz, who lives in New Rochelle, NY, had been on a waiting list for a kidney in New York State for five years. After learning about SPK from her neighbor and becoming Lim’s patient when he moved to RWJMS last summer, she received a call within two weeks. "That’s right," she says. "I picked up the phone and heard, ‘This is Robert Wood Johnson University Hospital. Your organs are here.’ I thought the transplant coordinator was joking." The next day as the anesthesiologist started the intravenous line to put her to sleep before surgery, Almaz knew it was no joke. "I wasn’t dreaming. It was true. I started crying." Lim explains that various reasons make the SPK route quicker and safer for sick patients, especially those who have diabetes, renal failure and are on dialysis. The waiting time is shorter for a combined pancreas/kidney than a kidney alone simply because there are fewer people on that particular list, according to Lim. The pancreas and kidney do not need to be from the same donor, in fact. When no living organ donor is available and biologically compatible, finding cadaver organs can be dangerous and time-consuming. "One-fourth of those on dialysis die each year," says Lim. In New Jersey, the wait for a kidney can be up to three to four years but only three to six months for qualified SPK candidates. Right now in the U.S., an estimated 50,000 people are looking for a perfectly matched kidney. Years of high blood sugar can damage the kidneys so badly that they no longer work. "Patients like Almaz need a way to rid the body of harmful wastes and extra salt and fluids and the options are dialysis and kidney transplantation," Lim says. Meanwhile, the pancreas, a long, thin gland that lies behind the stomach, is responsible for insulin. "If your pancreas doesn’t produce insulin, you are diabetic." Pancreas transplantation is the only therapy that can cure Type I diabetes, according to Lim, who has performed more SPK procedures since that first operation. With advances in surgical technique, improved immunosuppressant drugs and new insight into donor organs, the prognosis for the particular type of SPK surgery being done by Lim is promising. Almaz, for instance, was hospitalized for only a week and has experienced no complications. She didn’t even wake up nauseous as she had in past post-surgery situations. Other medical centers offering SPK often connect the donor pancreas to the bladder, which can cause dehydration, infection, acidosis, and pancreatitis in 10 to 20 percent of cases. Linking the pancreas to the bladder, as it is taught by some transplantation specialists, was believed to give physicians the best way of measuring transplant function later, but Lim points out, "It’s not really very accurate and with the rate of complications, we don’t do it." In fact, some surgeons have been forced to re-operate and connect the donor pancreas to the gastrointestinal system where it has a better chance of mimicking the body’s own physiology. "We do that from the very beginning," Lim says, "and we we don’t take the old pancreas out." Simultaneous organ transplants simply make good sense now, says Lim, who follows his patients’ progress closely, even memorizing home phone numbers. "I keep silly things like that in my head." Yet, silly is hardly the word Almaz uses to describe her doctor. Still on her own cloud nine, she says of Lim, "He is so down to earth." Almaz, one of 10 children – two brothers and seven sisters – says, "My whole family took turns sleeping in the hospital room when I was recovering." Two of her siblings are physicians and at this point in her life, Almaz is no longer as interested in computers, the profession for which she trained. "I’m researching masters’ programs in health related fields but I know that I want to help patients like myself. These past few months have felt like a miracle."
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Almaz
Woredekal is still flying high months after becoming the first UMDNJ
simultaneous pancreas/kidney (SPK) transplant patient. "I feel
as if I am up above the world and everyone in it," says this 38-year-old
computer information specialist who spent 30 years on insulin injections
as a result of Type I diabetes. For the past six, she was also on dialysis
four to five hours, three times a week. In June, with veins collapsing,
"I was at the very end of the rope," she explains. "I
was dying, bleeding a lot and I thought, ‘Oh my God, if I have
to go, let it be peacefully.’"