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Transplant Operation Brings Hope


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It happened, as always, without warning.

Wendy Kenny was driving her son Zach between neighbors' homes, collecting canned goods for a food drive, when she suddenly slipped into a trance.

Lines on the road became squiggles. Trees and traffic signs swirled into a kaleidoscopic haze.

Kenny doesn't remember much more.

But somehow she drove in her zombie state - with coaching from 13-year-old Zach - to a store, where he bought a lifesaving Coke for his mom, a diabetic. Her blood sugar had plummeted to a dangerous low.

I have no idea how we got to where we ended up,'' Kenny said.What if we had been on the freeway?''

The nightmare, last February, was one of dozens of potentially fatal incidents endured by the old Wendy Kenny.

The new Wendy Kenny hopes it never happens again.

More than two months ago, she received Georgia's first islet-cell transplant for diabetes at Emory University. The center is one of about 15 nationwide offering the procedure that could someday cure many diabetics.

During the surgery, a teaspoon of insulin-producing islet cells from a donor pancreas were infused into Kenny's liver. Since then, the 42-year-old pharmacist has kept her blood sugar level in check without the insulin shots she took daily for 33 years.

No more eerie, strokelike episodes that caused her to stare blankly at computer screens, awaken with seizures at night and wonder if any enjoyable moment might quickly morph into panic mode.

She's also at lower risk for complications from diabetes, including kidney failure, stroke, blindness and the need for leg amputation.

I'm an ex-diabetic now,'' Kenny said.When I hit the road now I don't even think about it. I don't even carry candy in the car anymore.''

Kenny was diagnosed at age 9 with Type 1 diabetes. Her immune system inexplicably attacked the islet cells in her pancreas, rendering them unable to make insulin, the hormone she needs to process sugar.

About 1 million Americans have this form of diabetes. Another 16 million have Type 2 diabetes, in which insulin is produced but not used properly, often due to inactivity and obesity.

Like all Type 1 diabetics, Kenny started insulin shots soon after learning she had the disease. Five times a day - morning and night and before each meal - she would stick a needle in her stomach, hip or thigh and deliver the life-sustaining fluid.

Sometimes, the insulin boost would be too great or her body would react to it oddly, and her blood sugar level would drop too low.

The resulting episodes seemed harmless at first. In junior high, she would occasionally oversleep. In high school, she would get unusually emotional some afternoons, crying and yelling at friends.

At age 20, while driving home from work one day, the white line on the road blurred into two lines. In college, her roommates had to rush Kenny to the emergency room when she started moaning from an episode while asleep.

Despite her regular shots and careful diet - no cookies, candy or cake - the low blood sugar episodes started coming on stronger and more frequently.

Unprecedented results

Kenny would break into sweats in the middle of the night, her arms and legs clenched from muscle spasms. Her husband, Steve, would come to the rescue with a spoonful of sugar, which she would try to suck down while shaking in bed.

I'd wake up looking like a Krispy Kreme donut,'' Kenny said.But if it wasn't for my husband, I'd be dead several times over.''

Last summer, her doctor at Emory told her about the Edmonton protocol - a procedure at the University of Alberta in Canada that might reduce or eliminate her need for insulin shots and prevent the low blood sugar episodes. Kenny signed up right away.

Islet-cell transplants had been attempted on diabetics since the 1970s but with limited success. In most of the 400 patients who received them, the donor cells died after a few days or didn't produce any insulin.

Beginning in 1999, researchers in Edmonton tried a new approach. They used different enzymes to process the islet cells and different immune suppresant drugs to prevent the patient from rejecting the transplant.

The technique yielded unprecedented results. All 10 initial patients were able to stop taking insulin shots or using insulin pumps. Their new islet cells continuously sensed their body's insulin needs and adjusted accordingly, like the cells do in people without diabetes.

By the time Kenny had the frightening spell while driving with her son this February, about 200 diabetics had received the new version of the transplant. Eighty percent of them were success stories.

Emory received a $4.1 million grant from the Juvenile Diabetes Research Foundation to start offering the new transplants, joining about 15 other centers.

Kenny was chosen to be the first islet-cell transplant recipient in Georgia.

She's a blonde who stands 5 feet 2 inches and weighs 120 pounds, and her small size made her an ideal candidate, as larger people often require cells from two or three pancreases. Doctors hoped Kenny could get by with just one.

She was also among the Type 1 diabetics with the greatest risk, due to her frequent low blood sugar episodes that could lead to coma and death.

The call from Emory came on a Friday morning while Kenny was at home doing the laundry. A pancreas was available, with what looked like plenty of good islet cells.

Kenny and her husband sped to Atlanta from nearby Covington. Then she sat on a hospital bed for more than six hours before learning the pancreas didn't have enough cells after all. The transplant was off.

The drill played out again two weeks later. This time Kenny's IV was hooked up and the anesthesiologist was on his way to bring her to the operating room when the surgery was canceled.

An instant success

The third time, on March 20, was a charm. The donor pancreas wasn't any larger than the others, but it produced more healthy cells.

Doctors pronounced Kenny's transplant an instant success. Not only did she need cells from just one pancreas, the cells started producing insulin almost immediately.

Many patients have to wait weeks before their new cells take hold. Kenny ended her reliance on injected insulin at 5:48 a.m. the day of her transplant, less than two hours after the procedure.

Her story isn't over, and the true ending may not be known for many months.

Many patients eventually require a second transplant. Some, after going without insulin injections for two years, have had to resume shots.

Even the new, more promising anti-rejection drugs have side effects that can lead to other medical problems.

But Kenny's indicators look promising so far, said Dr. Christian Larsen, who performed her transplant.

It looks like she'll be a single donor recipient,'' Larsen said.She's really got excellent blood glucose control.''

Life without insulin

Most people have about 100 milligrams of glucose, or sugar, per deciliter of blood at any given time. Kenny's pre-transplant blood glucose charts fluctuated from lows of 40 to highs of 350.

Her post-transplant charts stay mostly within the normal range of 60 to 150, centering around 100.

There are blips, like the 179 that showed up one evening shortly after the transplant.

``I had a potato,'' Kenny explained, her face scrunched up in guilt.

But even those aberrations are vast improvements from before, and they have been dwindling, Larsen said.

Emory did an islet-cell transplant on a second patient last week. Though the procedures are targeted at Type 1 diabetics, they may eventually also be used on people with Type 2 diabetes.

The university plans to add its own spin on the Edmonton protocol, using a new type of anti-rejection drug that is less toxic to the kidneys and less likely to increase cholesterol levels than the drugs used now, Larsen said.

Meanwhile, Kenny is enjoying her new life.

She still watches what she eats, and must prick her finger seven times a day to check her blood sugar level.

She takes nearly 20 tablets a day - anti-rejection medications, a cholesterol-lowering drug, a multivitamin and antivirals and antibiotics to keep infections at bay.

But she doesn't have to reach for her needles anymore.

Most important, Kenny no longer worries about suddenly blanking out or collapsing in the middle of whatever she is doing.

The weekend after she got home following the transplant, she took a fishing trip up north with Steve and Zach.

They brought a truck like the one she had driven while helping her son with the food drive.

This time, there was no fuzzy stupor, no anxiety at the wheel, no wondering where to get a sugar fix if she needed it.

There were just the dozen trout the family caught, took home and grilled for dinner.

A dinner without an insulin shot.

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(The Cox web site is at http://www.coxnews.com )

c.2003 Cox News Service

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