THE TEAM THAT MAKES IT HAPPEN

In an exclusive interview these surgeons explain the unique procedure that brings new hope to seriously ill diabetics – and recipients talk about the op that changed their lives
By Marí Hudson, Health24

It's one of South Africa's best kept medical secrets:
Joint pancreas and kidney transplants are being successfully performed on diabetics with kidney failure. Five years ago a Gauteng team of surgeons quietly made history with the first of these breakthrough operations.

ONE of them is an engineer, the other a hairdresser.
There’s also a lawyer, the father of a young child. Each developed type 1 diabetes as a child, had to inject insulin several times a day and spent hours every week connected to a kidney dialysis machine.

Besides kidney failure, other typical diabetes complications such as blindness and heart disease were always a possibility. Some of these patients were seriously ill and almost always exhausted.

Today the engineer crisscrosses the country on his motorbike; likewise, 31 other South Africans can for the first time conduct their lives without the burden of insulin injections and kidney dialysis. They won’t suffer from diabetes again thanks to an extremely delicate combined pancreas and kidney transplant.

A highly competent team of doctors from the University of the Witwatersrand, the only team in South Africa currently performing this operation, quietly changed the lives of these individuals.

It’s the same team of doctors who, while preferring to stay out of the headlines, still hit the front pages after health minister Dr Manto Tshabalala-Msimang’s successful liver transplant – something they also took care of. On 6 June 2002, 34-year-old Melanie Breedt from the East Rand became South Africa’s first pancreas and kidney transplant patient.

The team of doctors who carried out the double organ transplant were Dr Jean Botha, a South African who returned from Omaha in the USA to teach the team how to perform these difficult transplants, and Drs Russell Britz, René Botha (Jean’s father), Graeme Pitcher, Craig Joseph and Gary Fetter (who performs the majority of the extremely sensitive pancreas transplants), all of them from the department of surgery of the faculty of health sciences at the University of the Witwatersrand.

The chief anaesthetist was Dr Bill Wilson. The first transplant was carried out at the Garden City Clinic and since then most have been performed at the Wits Donald Gordon Hospital.

The first marathon operation lasted 18 hours and was carried out in four phases, with the surgeons taking over from each other. A pancreas transplant is especially complicated because it’s very easy to damage the organ during the process of removal and implantation.

Britz and Fetter explain that the risk of life-threatening complications such as inflammation of the pancreas (pancreatitis) and extended inflammation (septicaemia) is enormous.

A combined pancreas and kidney transplant is performed in four steps. The donor kidney and pancreas are harvested from the donor; the recipient is prepared; the donor pancreas is implanted in the stomach cavity without removing the original pancreas; and finally the kidney is transplanted. The last two phases combined last on average eight hours.

The effect of a functioning pancreas is so immediate and dramatic that patients’ glucose levels start returning to normal while they’re still under anaesthesia.

Like all transplant patients kidney and pancreas recipients also need to take anti-rejection medication. Because this medication can reduce one’s resistance to disease and because of other sideeffects, pancreas transplants are performed only when the patient also needs a kidney transplant.

The risk of a pancreas-only transplant for type 1 diabetics whose kidneys are still functioning is too high. Yet the transplant has to happen before there are serious diabetes complications; this means doctors work within a small window period.

A total of 32 of the 38 patients who received transplants over the past five years are still alive and 31 (80 per cent) are now able to eat sweets and fast foods and even go to gym – they’ve thrown away their insulin syringes.

Four patients died as a result of complications after this high-risk operation, two died from other causes although their pancreas and kidneys were in working order and one patient’s pancreas had to be removed within days of the operation because of complications.

Currently about 30 people with type 1 diabetes and kidney damage are waiting for a pancreas and kidney transplant. But because there’s a general shortage of organs – and on top of that so few donor pancreases are suitable – only about 10 transplants can be performed in a year. “If only our colleagues would send more donors to the transplant centres . . .” says Britz.

Most of the transplant patients who are now living without insulin injections and kidney dialysis cannot stop raving about their ‘new lives’. But the risks involved must not be underestimated

'MY LIFE HAS RETURNED TO NORMAL!’

MORNÉ HATTINGH (33)
HAIR STYLIST FROM THE STRAND

• Diagnosed as type 1 diabetic at two


• Kidney dialysis at 28


• Transplant: April 2007

At the age of five Morné had to start injecting himself with insulin. From an early age he was too sick to take part in sport and school camps were a nightmare because he couldn’t resist the temptation of eating too much cake.

Before he turned 30 his kidneys started failing and soon he had to undergo 12-hour kidney dialysis sessions three times a week. “After a while I didn’t have the energy to spend more than 10 minutes on my feet to do my work. There were times when I started wondering if such a life was worth it.”

Morné waited three years for a transplant. “I’ll never forget my first meal after the operation. Hospital steak had never tasted so good and I literally devoured it.” Morné no longer needs any injections or dialysis and he goes to gym regularly. “After the transplant it felt as though a bag of cement had been lifted off my back. Suddenly there is such a lot to be done and I’m constantly scared I might miss out on something.”

MELANIE BREEDT (39)
SWITCHBOARD OPERATOR FROM THE EAST RAND

• Diagnosed as type 1 diabetic at five


• Kidney failure at 20


• Transplant: June 2002

“My younger sister, Estie, died of diabetes complications a year before my transplant. She went blind and her kidneys failed. But the operation gave me a chance to live; today I’m once again full of life. I bake and potter in the garden like never before. I also think it’s high time the Breedt family had a baby girl.”

MELCHIOR MARX (32)
LAWYER AND SPORTSMAN FROM THE EAST RAND

• Diagnosed as type 1 diabetic at six


• Kidney dialysis at 29


• Transplant: February 2007

Melchior received provincial cricket colours in Standard 7 (Grade 9) and was a member of the SA wrestling team while at university.

Even when he had to undergo kidney dialysis twice a week he participated in sport. After his transplant he developed complications and had to spend months in hospital. It cost him more than R60 000 out of his own pocket.

“I’m grateful that my pancreas and kidney are working. I have far more energy and recently even played my first round of golf. But if I had to choose again I wouldn’t have had the transplants because of the complications.”

HERMAN MOSTERT (37)
ELECTRICAL ENGINEER FROM SOMERSET WEST

• Diagnosed as type 1 diabetic at 16


• Kidney dialysis at 32


• Transplant: April 2004

Three weeks after his transplant Herman was back at work. “I’m really enjoying dessert and can braai and have a beer with my friends over weekends. While I was on dialysis I couldn’t walk around my house without getting tired. After the transplant I bought myself a motorbike. I can now travel without worrying about where to find the nearest hospital for dialysis.”

HILDA LANCIA VAN DER MERWE (41)
(PICTURED HERE WITH HUSBAND JOHAN)
BOOKKEEPER FROM PRETORIA

• Diagnosed as type 1 diabetic at eight


• Kidney dialysis at 36


• Transplant: July 2006

“The whole experience was just one great miracle.”

NOLUNDI LUTHULI (29)

• Diagnosed as type 1 diabetic at 12


• Kidney dialysis at 25


• Transplant: August 2006

“I suffered enough from diabetes – my sight became affected – but today I feel like a new person. My message to others going through the same process is to never give up hope.”

YOU Pulse Summer 2007/8

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