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David Esser
A Brighter Road Ahead
By Abby Sinnott
Thanks to an innovative kind of transplant offered at UCSF, a 44-year-old father of two young boys declared, "I no longer have a dark cloud hanging over my head. My condition had become an inconvenient part of my life that always seemed to strike at the wrong times."
Since 1993, David Esser, a private banker residing in Montara, Calif., had suffered from severe chronic pancreatitis, a condition that causes ongoing inflammation and irreversible scarring of the tissue in the pancreas, resulting in severe and unpredictable attacks of back and abdominal pain.
Esser's pancreas had stopped producing the enzymes necessary for his body to digest and absorb nutrients. His condition also caused him to develop pancreatic cysts the "size of coffee cups," which greatly increased his risk for developing pancreatic cancer. In its advanced stages, pancreatitis also can lead to diabetes and organ failure. Although the cause of the condition is often unknown, Esser's disorder resulted from a congenital defect of his pancreatic ducts, known as pancreatic divisum.
Esser is the third patient at UCSF Medical Center's Islet and Cellular Transplantation Center to have received what is known as an islet autotransplantation. This innovative procedure is the first of its kind; it helps alleviate the pain caused by chronic pancreatitis, while preserving a patient's ability to secrete insulin and reducing his or her risk of developing surgically-induced diabetes.
Normally, for patients like Esser, whose pain is not relieved by medication and other approaches, partial or entire surgical removal of the pancreas, called a pancreatectomy, is recommended. While a pancreatectomy typically relieves a patient's pain, it induces permanent diabetes, requiring insulin shots or the use of an insulin pump for the rest of a patient's life. This is because the pancreas contains islets of Langerhans — also known as islets — which regulate the body's blood sugar levels by secreting insulin.
During an islet auto (meaning "self") transplantation, the patient's own islets are isolated from their removed pancreas and then put back into the patient, where they start producing insulin. This may prevent diabetes from developing or make the diabetes milder than if a patient had had just a pancreatectomy, which guarantees that they will become permanently insulin-dependent.
An islet autotransplantation with a pancreatectomy is a complicated procedure that requires expertise and training provided by only a select few medical centers and doctors in the world. The centers team of Dr. Andrew Posselt, director of the islet transplant program, and Dr. Hobart Harris, chief of general surgery, performed Esser's surgery in 2006; Harris performing Esser's partial pancreatectomy and Posselt conducting the subsequent islet isolation and autotransplantation.
"I was extremely scared when I was told I had to have surgery," Esser says. "But Dr. Harris walked me through the entire process; he has true compassion for the human condition. A great pair of hands doesn't just cure fear, education and confidence in your surgeon does."
"In many ways, David is exactly the kind of person that we hope to help with this procedure," said Harris, who is dedicated to expanding the islet autotransplantation program at UCSF. "Like many patients with chronic pancreatitis, he is entering the very prime of life, yet this debilitating and progressive illness threatened to put everything on hold."
Now, after more than a decade of suffering from severe pain, Esser avid says his pain levels have dropped by 70 percent, and his islets are functioning at full capacity, producing normal amounts of insulin.
Most importantly, however, Esser said he has hope for tomorrow and the road ahead. "Islet autotransplantation offers a preemptive measure that can be life, as well as quality of life, saving," Esser said. "My 'what ifs' are no longer about getting sick. My 'what ifs' are now only about the good things ahead for me and my family."
Abby Sinnott is a freelancer writer in San Francisco.
Photo by Mark Estes
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