Combined islet-lung transplantation in a cystic fibrosis patient.
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.
Bühler
L
L
Clinique de chirurgie digestive, Hôpital cantonal universitaire de Genève.
Andereggen
E
E
Deng
S
S
Spiliopoulos
A
A
Nicod
L
L
Rochat
T
T
Tschopp
J M
JM
Cretin
N
N
Fournier
B
B
Conrad
B
B
Mentha
G
G
Morel
P
P
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
D007166:Immunosuppressive Agents