Combined pancreatic islet-lung transplantation: a novel approach to the treatment of end-stage cystic fibrosis.
Patients with end-stage cystic fibrosis (CF) and severe CF-related diabetes (CFRD) may benefit from combined lung-pancreatic islet transplantation. In the present study, we report the long-term follow-up of four end-stage CF patients treated with combined bilateral lung and pancreatic islet transplantation from the same donor. All patients were C-peptide negative (<0.5 microg/L) and inadequately controlled despite intensive insulin treatment. One patient was transplanted with 4 019 +/- 490 islet equivalent/kg injected into the transverse colic vein using a surgical approach. In the remaining three patients, islets were cultured for 3-6 days and transplanted by percutaneous transhepatic catheterization of the portal vein. In all patients, islet allograft recovery was recognized by elevation in the plasma level of C-peptide (>0.5 microg/L). At 6 months after transplantation, one patient showed multiple episodes of acute lung transplant rejection and a progressive decline in pancreatic islet cell function. Three out of four patients experienced an improved control of glucose levels with a HbA1c of 5.2%, 7% and 6% respectively at 1.5, 2 and 15 years follow-up. Compared with the pretransplant period, there was a 50% reduction in mean daily insulin needs. Pulmonary function remained satisfactory in all patients. In conclusion, our cases series shows that combined bilateral lung and pancreatic islet transplantation may be a viable therapeutic option for patients with end-stage CF and CFRD.
Kessler
L
L
Department of Diabetology, University Hospital, University of Strasbourg, France. laurence.kessler@chru-strasbourg.fr
Bakopoulou
S
S
Kessler
R
R
Massard
G
G
Santelmo
N
N
Greget
M
M
Moreau
F
F
Helms
O
O
Bosco
D
D
Gasche-Soccal
P
P
Morel
P
P
Wolf
P
P
Berney
T
T
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002096:C-Peptide / Q000097:blood; D003131:Combined Modality Therapy; D003550:Cystic Fibrosis / Q000150:complications / Q000601:surgery*; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics; D048909:Diabetes Complications / Q000601:surgery; D005541:Forced Expiratory Volume; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D009154:Mutation; D017384:Sequence Deletion; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult
D002096:C-Peptide; D019005:Cystic Fibrosis Transmembrane Conductance Regulator