Combined liver and islet transplantation using steroid-free immunosuppression.
Due to a vicious circle in which HCV favors insulin resistance and, alternatively, insulin resistance facilitates the persistence of HCV, HCV patients have often diabetes associated with liver cirrhosis. We present the case of combined liver and pancreatic islets transplantation performed in a patient with HCV liver cirrhosis associated with insulin-dependent diabetes. This is also the first case of islet allotransplantation in Romania. A 40-year-old male diagnosed with liver cirrhosis due to HCV infection and insulin dependent diabetes underwent combined liver and islet transplantation. Our therapeutic design was based on data provided by both the use of Edmonton immunosuppressive steroid-free protocol in islets cell transplantation and the findings of international studies on the effects of this protocol in liver transplantation for patients with HCV infection. Good metabolic control of the diabetes was obtained. The absence of anti beta cell autoimmunity could explain also the good tolerance for the transplanted islets, proved by the rapid and durable decrease of the insulin need, from 64 U/day to 20 U/day at one month post-transplantation, dose that was maintained for 16 months when the patient died due to recurrent HCV hepatitis. Islet transplantation can be associated to liver transplantation in order to improve the associated diabetes in cirrhotic patients.
Popescu
I
I
Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. irinel.popescu@icfundeni.ro
Dima
Simona
S
Guja
C
C
Gheorghe
Liana
L
Iacob
Speranţa
S
Hrehoreţ
Doina
D
Matei
E
E
Dorobanţu
B
B
Botea
F
F
Sârbu
V
V
Tulbure
D
D
Ionescu-Tîrgovişte
C
C
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000601:surgery*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D012008:Recurrence; D014184:Transplantation, Homologous
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents