Transplant Patient Celebrates Two Birthdays in One Month
Dual Kidney and Pancreas Transplant Can Cure Diabetes and Transform Lives
Last month, Lara Holmes celebrated two birthdays—her normal birthday, and the first birthday since she received the gift of a lifetime: a new pancreas and kidney.
In April 2020, against the backdrop of the uncertain early days of the COVID-19 pandemic, Holmes received the phone call that a pancreas and kidney were available.
As she was wheeled into the operating room, Holmes—who had endured Type 1 diabetes for 39 years—channeled the famously logical characters from "Star Trek."
"I tried to be kind of like a Vulcan and kind of be unemotional, because, on one hand, I was nervous, but I didn't let that bother me because I wanted this for so long," Holmes said.
Todd Brennan, MD, director of Cedars-Sinai's Pancreas Transplant Program, and Irene Kim, MD, co-director of the Comprehensive Transplant Center, then performed Holmes' dual pancreas and kidney transplant—a marathon surgery that took nearly eight hours.
Two days later, still recovering from the surgery, a groggy Holmes blew out a fake candle as her nurses sang "Happy Birthday" to her. Thanks to the transplant, Holmes was no longer diabetic.
"I couldn't believe it. I was like, 'I am doubly blessed right now. You guys are awesome,'" Holmes said. "I got the best birthday gifts ever."
A Life-Changing Surgery
The pancreas transplantation surgery that cured Holmes' diabetes is a rare and complex procedure used to cure patients who suffer from secondary complications of diabetes, such as vascular disease, kidney disease and retinopathy, all of which can occur even in patients with well-controlled diabetes. It replaces the pancreas, which in Type 1 diabetics no longer produces enough insulin, with a well-functioning donor organ.
In Holmes’ case, she was vigilant about checking and controlling her blood sugar, but the diabetes, along with a secondary complication, a rare condition called Henoch-Schönlein purpura (HSP), caused a rapid decline in her kidney function, leading her to be eligible for the dual transplant procedure.
Pancreas transplantation is rare—fewer than 1,000 were performed in all of the U.S. last year, according to the United Network for Organ Sharing (UNOS), which manages the nation's organ transplant system—and it's not right for every diabetic patient. The surgery is complex and, as with all surgeries, involves some risk. But Brennan said that, when it's indicated, the pancreas transplantation surgery can have some life-changing benefits.
"Patients who undergo a pancreas transplant are completely cured from diabetes," he said. "They don’t have to continue taking insulin."
When performed in conjunction with a kidney transplant, as in Holmes' case, the benefits can be even greater. It can reverse the effects of diabetic nephropathy, or kidney failure, which is a common complication of the disease. Receiving a new kidney can extend the life of a patient, and receiving both a new pancreas and a new kidney can help prevent further kidney damage.
"The difference in life expectancy for someone who has a kidney and pancreas transplant compared to someone who remains without is decades," Brennan said. "It's an amazing difference in lifespan."
Interestingly, surgeons don't usually remove the old organs during these surgeries—meaning that Holmes now has three kidneys and two pancreases, perhaps making her a little more like those ever-logical Vulcans than she imagined.
A Beginning and an End
For Holmes, the transplant was the beginning of a new, diabetes-free, era. But it was also an ending of sorts—an ending to a long fight against the disease.
She was diagnosed with diabetes just a few weeks before her 14th birthday, and spent years injecting herself twice daily with insulin, and later using an insulin pump to control her blood sugar. Her constant worrying about her health limited her ability to experience new things like traveling.
When her kidneys showed signs of failure in 2019, she reluctantly began to undergo dialysis, another time-consuming and life-altering treatment.
"I had to go three times a week, minimum, and I had to set aside like four hours each time," she said. "And after the dialysis, I would just crash, because I was super tired, and I was just kind of useless for the rest of the day. It was awful."
Holmes credits her nephrologist, Jeffrey Glick, MD, with bringing up the topic of transplantation and eventually convincing her to apply for the kidney/pancreas waitlist. Doing so meant Holmes needed to see a variety of different specialists to make sure she was eligible for the procedure.
In September 2019, she got the call she had been waiting for—she had been placed on the transplant list.
Holmes describes the process that followed—that of preparing for a transplant—to being in school.
"They give you a workbook and you have to learn about all these different things, like how antibodies work," she said.
She began taking immunotherapy treatments to reduce her chances of organ rejection. These drug therapy protocols, developed by Stanley C. Jordan, MD, director of the Transplant Immunology Laboratory, significantly reduce the risk that a kidney transplant patient's immune system will reject the new organ.
Holmes also began meeting the care coordinators and specialists who would become an integral part of her transplant journey.
Holmes recalls that the first time she met Brennan, the first thing Brennan noticed was the anime characters on her socks. She was impressed that he recognized one of the characters from the film "Spirited Away."
"We started talking about anime, and then we just started talking about all things nerdy," Holmes said. "We realized that we were both nerds. We just clicked. I have a lot of cool doctors, but I was like, 'This guy is the coolest doctor ever.'"
That coolness factor also put Holmes' husband, Mark, who usually wasn't comfortable in hospitals or medical settings, at ease.
"He was so nervous, but when he met my transplant coordinator, Kathryn, and Dr. Brennan, he felt so much better," Holmes said.
That added level of comfort made all the difference when Mark dropped her off for her surgery in April 2020. Due to the pandemic, visitor hours were limited, and Mark couldn't stay as long as they had originally planned. But she said he felt confident she was in good hands.
Live Long and Prosper
Holmes' wait on the transplant list was short—just seven months. She said she realizes that she is one of the lucky ones. Transplant wait times can be long, even when the need for an organ is urgent. But Cedars-Sinai's record is strong. In fact, 92.3% of kidney-pancreas transplant patients on the Cedars-Sinai waitlist have received a transplant within three years, compared to a national average of 60.4%.
"I'm just thankful every day now that this happened," she said.
Read more on the Cedars-Sinai Blog: Cultural Challenges of Organ Donation