DOUBLE TRANSPLANT GIVES VALLEY RESIDENT NEW HOPE: WOMAN RISES TO CHALLENGE; EXPERIMENTAL SURGERY COULD HELP DIABETICS.

Byline: Anne Burke Daily News Staff Writer

After raising six kids alone on a housekeeper's wages, Annie Ramirez thought she had survived enough trials and tribulations to last a lifetime.

But fate had something else in store for the 52-year-old Canoga Park woman.

Her biggest challenge arrived last month, when Ramirez became UCLA Medical Center's first recipient of an experimental transplant involving a liver and islet cells, the insulin-producing part of the pancreas.

The double transplant was necessary to treat the diabetes and hepatitis C she had been diagnosed with in the 1980s.

``It was kind of scary,'' said Ramirez, recuperating at home after the Nov. 12 surgery. ``But if it can help other people who have the same problem, then it's worth it.''

Ramirez's islet surgeon, Dr. Craig Smith, said the operation holds potential promise for people with Type 2, or adult-onset, diabetes, for whom islet transplants were previously thought to be ineffective.

Physicians hope Ramirez's transplanted islets eventually will produce all the insulin her body needs. Already, her daily requirement has fallen by about one-third, Smith said.

That's good news for Ramirez and her son, Ernie, 27. He's on leave from his job as an auditor in the San Francisco Bay Area to take care of his mother.

``Before, she would get five to six injections a day,'' he said. ``Now she gets insulin in the morning, and maybe another injection later in the day.''

More than 15 million Americans older than 20 - the highest-risk age group - have diabetes, according to the American Diabetes Association.

Ramirez's new liver and islets came from the same donor, a 60-year-old Los Angeles man. After the liver was transplanted, the islets were injected into a vein leading to the new organ, Smith said.

The immunosuppression drugs Ramirez takes to fight rejection of her new liver are also helping her body accept the new islet cells.

Surgeons and researchers hope to perfect the procedure so that islet cells can be injected into people who do not need a separate organ transplant, Smith said.

While islet transplants are not new, liver-islet transplants in people with Type 2 diabetes are rare. Fewer than a dozen have been performed in the country, Smith said.

Three of the operations were conducted at the University of California, Irvine, by a consortium to which Smith belongs. Those patients are doing well and are off insulin entirely, he said.

Many islet transplants are performed on diabetics who are undergoing the transplant of a kidney, enabling them to benefit from immunosuppression drugs, said Dr. Richard Bergman, a diabetes researcher at the University of Southern California.

Surgeons also are experimenting with other methods of transplanting islet cells into diabetics. One method involves cells that have been coated with a seaweed-based capsule to protect them from antibodies that cause rejection.

However, such procedures are fraught with problems due to the poor availability of the islets and rejection of such cells, doctors said.

``I'm not personally that hopeful that, in the near future, this will be a common therapy for Type 2 diabetics,'' Bergman said.

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PHOTO Annie Ramirez, left, is being cared for by family members such as her son, Ernie; her mother, Lupe Chavez; and her daughter, Vivian.

Evan Yee/Daily News