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Published in CenterView on December 16, 2013
Paul Davis, left, and Dr. Mark Earl
Paul Davis, left, and Dr. Mark Earl

Pancreas recipient plans to discard insulin, terminate dialysis

By Jack Mazurak

The red tattooed medical star emblazoned with the word “DIABETIC” on the back of Paul Davis’ left hand indicates he’s no ordinary guy.

Countless blackouts from low-blood-sugar episodes, a result of his type 1 diabetes, have made the tattoo useful for informing police, medics, fellow weightlifters at the gym and passersby.

At the University of Mississippi Medical Center on Dec. 5, the 49-year-old Davis, a bodybuilder from Monticello and former off-shore worker and security guard for rock stars including Ted Nugent, received the institution’s first transplanted pancreas, a big victory in his battle with the disease.

During the operation, Davis also received a kidney. Together, the donor organs should control the autoimmune condition he’s fought since the age of 9.


Davis’ left hand indicates his prior medical status.
Davis’ left hand indicates his prior medical status.

“(The tattoo) means a lot to me. It means saving my life,” said Davis, a guy who bench presses 460 pounds and approaches life with all the lets-go attitude of a pit bull.

Dr. Mark Earl, assistant professor of transplant surgery, who performed the operation, said the new pancreas will prolong the life of Davis’ new kidney which, to a large degree, will prolong his life.

“This procedure will improve quality of life and provide a significant survival benefit over dialysis and insulin therapy,” Earl said. “While we celebrate this success and what our first pancreas transplant means for Mississippians in the future, we also sincerely thank the donor family.

“They lost someone irreplaceably special, yet made an incredibly life-affirming decision to donate.”


Drs. Steven Wagner, left, and Mark Earl, center, speak with Paul Davis of Monticello following his kidney and pancreas transplant.
Drs. Steven Wagner, left, and Mark Earl, center, speak with Paul Davis of Monticello following his kidney and pancreas transplant.

During a 24-hour span that included Davis’ milestone operation, UMMC teams transplanted five organs into four Mississippians. Other patients received a heart, left kidney and liver.

Davis’ operation builds on UMMC’s record of firsts, said Dr. Marc Mitchell, professor and chair of the Department of Surgery.

“It’s remarkable how far organ transplant at this very institution has come, from Dr. James Hardy transplanting the first human lung just over 50 years ago to these recent outstanding achievements,” Mitchell said. “With operations like these, we’re giving UMMC trainees first-rate experiences. They’ll use these skills to serve the health-care needs of our state and the world.”

The operation also marked the final piece of UMMC’s abdominal transplant line.

“Our goal has been to build a complete and high-functioning abdominal transplant program,” said Dr. Christopher Anderson, associate professor of transplant surgery and division chief of transplant and hepatobiliary surgery. “The pancreas transplant program represents that last piece of the abdominal program and is the culmination of a lot of hard work from our transplant team and the entire institution.

“University Transplant can now serve the state’s kidney, liver and pancreas needs while keeping patients close to home.”

The transplant program began administrative and logistical preparations about a year ago for the first pancreas transplant. In late September, University Transplant received pancreas approval from the United Network for Organ Sharing, the nation’s nonprofit oversight organization for transplantation.

“The patient was listed in October and we’ve been waiting on suitable organs to become available,” Earl said. “Organs for transplantation are an incredibly scarce, precious resource and a pancreas is one of the rarest.”

Transplants require broad coordination between medical and surgical faculty members, the Mississippi Organ Recovery Agency, operating room nurses, techs, administration, laboratory staff, blood bank employees, intensive care unit members and transplant-floor nurses.

The continuum of care surrounding each transplant, including the four last week, speaks to the caliber of employees at UMMC, said Dr. William Little, professor and chair of the Department of Medicine.


Holding court at a Dec. 13 press conference are, from left, Dr. Steven Wagner, Paul Davis and Dr. Mark Earl.
Holding court at a Dec. 13 press conference are, from left, Dr. Steven Wagner, Paul Davis and Dr. Mark Earl.

“When you look at how many people play a role in operations like these, the care beforehand, preparation, execution and long-term follow-up, it really indicates the high quality of care at our institution,” Little said. “You also have to recognize, many UMMC faculty members, fellows and students research the very diseases that Mississippians suffer most, including heart disease, diabetes, liver, kidney, obesity and hypertension.

“In that sense, we’re working to prevent disease progression that leads to organ failure.”

The pancreas is located deep in the abdomen, behind the stomach, and is connected to the small intestine. It produces insulin, several other hormones and pancreatic enzymes, which it secretes into a person’s intestine.

The pancreatic enzymes help break down carbohydrates, protein and fats during digestion. The hormones help the body regulate blood sugar levels.

Dr. Kenneth Kokko, associate professor of nephrology and medical director of the Renal Transplant Program, said the pancreas will prolong the life of the patient’s new kidney.

“It could also have the added benefit of preventing severe hypoglycemic episodes which further complicate the care of these patients,” Kokko said.

Hypoglycemia – or low blood sugar – is what caused Davis to often black out. Because he has hypoglycemic unawareness, his body’s sympathetic nervous system doesn’t give him a warning like sweating or shakiness to indicate low blood sugar.

“I had actually blacked out when they called about transplant,” Davis said. “They called five times, then called my sister, who came in and found me. My blood sugar was 36. It’s normally 150.”

Dr. Steven Wagner, assistant professor of nephrology, said years of diabetes weakened Davis’ kidneys.

“The reason he has diabetes is that his pancreas is not making insulin,” Wagner said. “Replacing the pancreas will effectively treat his diabetes and he shouldn’t need to inject insulin any more.

“That’s pretty life changing, to not have to inject. Diabetes ends up controlling your life.”

Thanks to the new kidney, Davis also will likely stop dialysis, an all-night, every-night process he did at home for the past two years.

Wagner said Davis’ healthy lifestyle, frequent workouts and muscle mass – which helps regulate blood sugar –made him a good candidate.

“He was doing a really good job with his diabetes,” Wagner said. “His efforts to maintain his fitness probably kept him alive.”

Asked what he’ll do with the leftover insulin sitting in his fridge, Davis pointed to the trash can.

“I’ve been giving myself four shots a day since I was 30 years old,” he said. “I guess I got used to it because it was my routine. But I’m not going to miss it.”

Many of the 15 surgeries he’s endured throughout the years, including the removal of six toes, relate to his diabetes. Eight operations alone were performed on his eyes to stave off diabetic retinopathy.

None of that slowed him down long.

“If you let yourself get down about things, you’re going to get sicker. I don’t ever feel sorry for myself,” said Davis, who had a Superman emblem tattooed over his heart in 1994. That tattoo, he’ll keep.

“I’m going to get this one removed,” he said indicating the diabetic warning on his hand. “It’s been good to have, but not needing it is even better.”

To date, University Transplant has completed 98 kidney, 19 liver and six heart transplants in addition to the first pancreas.

   

Four interesting notes about the pancreas

1) The pancreas is part of both the digestive system – helping to break down food – and the endocrine system – producing hormones, including insulin.

2) Anatomically, the pancreas receives blood through two arteries, but on donor organs, surgeons graft together a single supply artery.

3) Transplanted pancreases go into a different location – lower and shallower than the native pancreas.

4) In transplant, surgeons leave the original pancreas in place; removing it would add risk to the procedure, and the patient couldn’t survive if the transplanted organ failed.