Rare Insulin Allergy Leads to Creative Anesthesia Approach for Pediatric Pancreas Transplant Surgery

When Emmy Reeves needed a whole pancreas transplant, a first of its kind surgery that doctors in the United States have performed in nearly two decades, University of Minnesota anesthesiologists were to play a crucial role.

Emmy was diagnosed with type 1 diabetes mellitus when she was four years old, but after her first insulin injection, she experienced an unusual and intense reaction that included difficulty breathing and a rash. After testing, doctors discovered that Emmy had a rare allergy to the artificial insulin delivered by the injections.

“Every time I give her a shot she describes it as a burning sensation that spreads from that spot throughout her whole body,” Tiffanie Reeves, Emmy’s mother, said.

Emmy’s doctors in South Carolina were able to control the allergic reactions with antihistamines and pain medication; however, Emmy’s parents and care providers learned that her allergy was causing internal damage—in addition to her rashes and breathing difficulty. Her eyes and her nerves were damaged by her type 1 diabetes, and the amount of antihistamines and pain medication she required took a toll on her quality of life.

Emmy’s medical condition is rare, and the family was out of options, so they sought a better solution at University of Minnesota Health. After assessing the case, it was decided that the best long-term solution would be a whole pancreas transplant, which is highly uncommon in pediatric patients.

“We were the first place in the world to do a pancreas transplant,” said Anesthesiologist Dr. Kumar Belani, “We have the expertise with pancreases and have built our expertise in transplants in children over a long time.”

Emmy wasn’t only allergic to insulin, but had a long list of allergies, which made this surgery even more complex.

“She has multiple allergies, and that complicates the case from an anesthesia point of view, especially in relation to pain medicines,” said Dr. Belani, “We had to come up with a special plan for pain management and worked with the pharmacy and our pain specialists to develop a treatment plan that would work.”

Emmy was put on the transplant list, and after waiting 210 days, the family got the call they were waiting for.

“Everything fell into place,” said Dr. Anand, the Anesthesiologist on-call when Emmy’s pancreas became available, “The surgery went without a glitch. With proper preparation, planning and the department’s prior experience, we were able to manage her problems while providing the personalized intraoperative support she needed; she did really well.”

After the surgery, Emmy’s healthy pancreas took over and began producing insulin for her body. Emmy, currently 13 years old, is now insulin independent, which means she no longer needs insulin injections—or the medication to counter the allergic reactions she experienced after each injection. She will be monitored closely for the first year post-transplant, but currently she is recovering well.

“There aren’t many places in the world with our expertise that could have done this surgery,” said Dr. Belani, “Pediatric cases like this require a team approach and skill in various specialties and we have that at the University of Minnesota.”

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