Bilateral sequential lung and simultaneous pancreas transplant: a new approach for the recipient with cystic fibrosis.
Cystic fibrosis (CF) is an inherited disorder that presents in childhood as a multisystem disease. Pulmonary failure and pancreatic insufficiency, including CF related diabetes (CFRD) and exocrine insufficiency, are common complications of this disease. In this report we review the first three simultaneous lung and pancreas transplantations in CF patients with diabetes.


METHODS
All three CF patients presented for evaluation for lung transplantation and had pancreatic insufficiency requiring enzyme supplementation and CFRD requiring insulin. All were severely malnourished and required nutritional supplementation.


METHODS
In each case, the allografts were procured from a single cadaveric donor. Bilateral lung transplantation was performed first using two separate thoracic incisions. The pancreas transplant was performed with systemic venous drainage and enteric exocrine drainage.


RESULTS
The pancreas allografts all functioned normally with normoglycemia independent of insulin. As a result of the enteric drainage of the pancreas allograft, supplemental pancreatic enzymes were no longer required. Despite several complications detailed in the manuscript, all three remain independent of supplemental oxygen, insulin and pancreatic enzyme replacement at 4, 6 and 14 months of follow-up.


CONCLUSIONS
Simultaneous lung and pancreas transplantation in patients with CF can be performed successfully and provides the advantages of normoglycemia and improves nutrition for patients requiring lung transplantation.
Fridell
Jonathan A
JA
Indiana University School of Medicine, 550 N University BLVD, #4258, Indianapolis, Indiana 46202, USA. Electronic address: jfridell@iupui.edu.
Wozniak
Thomas C
TC
Methodist Hospital, Indianapolis, IN, USA.
Reynolds
John M
JM
Methodist Hospital, Indianapolis, IN, USA.
Powelson
John A
JA
Indiana University School of Medicine, 550 N University BLVD, #4258, Indianapolis, Indiana 46202, USA.
Hollinger
Edward F
EF
Indiana University School of Medicine, 550 N University BLVD, #4258, Indianapolis, Indiana 46202, USA.
Duncan
Michael W
MW
Methodist Hospital, Indianapolis, IN, USA.
Sannuti
Aruna
A
Indiana University School of Medicine, 550 N University BLVD, #4258, Indianapolis, Indiana 46202, USA.
Milgrom
Martin L
ML
Indiana University School of Medicine, 550 N University BLVD, #4258, Indianapolis, Indiana 46202, USA.
D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications / Q000601:surgery*; D003920:Diabetes Mellitus / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D016035:Pancreas Transplantation