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Scientific article
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Feasibility and efficacy of combined pancreatic islet-lung transplantation in cystic fibrosis related diabetes - PIM study: a multicenter phase 1-2 trial

Publication date2022-04-11
First online date2022-04-11
Abstract

Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis (CF), and restoring metabolic control in these patients may improve their management after lung transplantation. In this multicenter, prospective, phase 1-2 trial, we evaluate the feasibility and metabolic efficacy of combined pancreatic islet-lung transplantation from a single donor in patients with CFRD, terminal respiratory failure, and poorly controlled diabetes. Islets were infused via the portal vein under local anesthesia, 1 week after lung transplantation. At 1 year, the primary outcome was transplant success as evaluated by a composite score including four parameters (weight, fasting glycemia, HbA1c, and insulin requirements). Ten participants (age: 24 years [17-31], diabetes duration: 8 years [4-12]) received a combined islet-lung transplant with 2892 IEQ/kg [2293-6185]. Transplant success was achieved in 7 out of 10 participants at 1-year post transplant. Fasting plasma C-peptide increased from 0.91 μg/L [0.56-1.29] to 1.15 μg/L [0.77-2.2], HbA1c decreased from 7.8% [6.5-8.3] (62 mmol/mol [48-67]) to 6.7% [5.5-8.0] (50 mmol/mol [37-64]), with 38% decrease in daily insulin doses. No complications related to the islet injection procedure were reported. In this pilot study, combined pancreatic islet-lung transplantation restored satisfactory metabolic control and pulmonary function in patients with CF, without increasing the morbidity of lung transplantation.

Trial registration: ClinicalTrials.gov NCT01548729.

eng
Keywords
  • Cystic fibrosis
  • Islet transplantation
  • Lung transplantation
  • Respiratory failure
  • Secondary diabetes
Citation (ISO format)
RAKOTOARISOA, Luc et al. Feasibility and efficacy of combined pancreatic islet-lung transplantation in cystic fibrosis related diabetes - PIM study: a multicenter phase 1-2 trial. In: American journal of transplantation, 2022. doi: 10.1111/ajt.17058
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ISSN of the journal1600-6135
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