title: Combined islet-lung transplantation in a cystic fibrosis patient.
abstract: The prevalence of insulin-dependent diabetes mellitus (IDDM) in cystic fibrosis patients ranges from 2 to 8% and glucose intolerance up to 15%. In recent years, lung transplantation has helped to prolong life expectancy of cystic fibrosis patients and represents 10 to 30% of all indications for lung transplantation. The postoperative need for immunosuppressive therapy using diabetogenic agents has decompensatory effects on glucose regulation and will probably increase the number of insulin-dependent cystic fibrosis patients. We report the case of an insulin-dependent cystic fibrosis patient transplanted with a combined islet-lung allograft. The pre-transplantation C-peptide level was below 0.04 nmol/l and preoperative insulin requirement was some 100 U per day. A sequential bipulmonary lung transplantation was performed and, using the pancreas of the same donor, we isolated and purified the islets of Langerhans by a modified automated method. We obtained 232,200 islets equivalent, which were injected into the liver by portal embolization. The postoperative course was uncomplicated, the insulin requirement decreased to 50% of the preoperative need and the C-peptide value increased to normal values and remained with the normal range during a follow-up period of 15 months. In conclusion, we believe that, besides type I diabetic patients, insulin-dependent cystic fibrosis patients with a negative C-peptide value could also be good candidates for combined islet-lung allotransplantation.
authors.affiliation: Clinique de chirurgie digestive, Hôpital cantonal universitaire de Genève.
authors.forename: L
authors.initials: L
authors.lastname: Bühler
authors.forename: E
authors.initials: E
authors.lastname: Andereggen
authors.forename: S
authors.initials: S
authors.lastname: Deng
authors.forename: A
authors.initials: A
authors.lastname: Spiliopoulos
authors.forename: L
authors.initials: L
authors.lastname: Nicod
authors.forename: T
authors.initials: T
authors.lastname: Rochat
authors.forename: J M
authors.initials: JM
authors.lastname: Tschopp
authors.forename: N
authors.initials: N
authors.lastname: Cretin
authors.forename: B
authors.initials: B
authors.lastname: Fournier
authors.forename: B
authors.initials: B
authors.lastname: Conrad
authors.forename: G
authors.initials: G
authors.lastname: Mentha
authors.forename: P
authors.initials: P
authors.lastname: Morel
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male
chemical_list: D007166:Immunosuppressive Agents