Triple Transplant

Progress in transplanting human organs other than the kidney has been disappointingly slow, not only because of rejection reactions but also because of technical difficulties in surgery. Last week surgeons at the University of Minnesota Hospitals in Minneapolis were anxiously watching the progress of the first patient to receive a triple transplant--kidney, pancreas and duodenum.

The 32-year-old woman was a victim of a "brittle" and "malignant" form of diabetes that develops in early life and eventually damages nearly all the body's arteries, including those supplying the kidneys. In this case, the patient's kidneys had already failed, and she was being kept alive by dialysis. Her pancreas was functioning poorly. The doctors were equally concerned about the working of her duodenum, a source of little-understood hormones.

Last New Year's Eve, another woman died at the hospital from the effects of a stroke. Dr. William D. Kelly and Dr. Richard C. Lillehei already had permission to remove the organs they needed. They took out the conjoined pancreas and duodenum as a unit and also took a kidney. They implanted the kidney near the patient's right groin. Then, instead of replacing her own pancreas and duodenum with the graft, they left her digestive tract intact and implanted the entire new unit in the left iliac fossa, just above the groin. It is hooked up to her arteries and veins, so it spills its hormones into the bloodstream, where they augment the output of her own failing organs.

The additional duodenum is not yet connected directly to the digestive tract. It will be hooked into a loop of the small bowel in about a month if the transplant remains healthy. So far, the transplanted kidney has effectively filtered the patient's blood and made urine; the pancreatic-duodenal graft has done its work so well that she has needed no insulin since her surgery.

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