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Title

Combined pancreatic islet-lung transplantation: a novel approach to the treatment of end-stage cystic fibrosis

Authors
Kessler, L.
Bakopoulou, S.
Kessler, R.
Massard, G.
Santelmo, N.
Greget, M.
Moreau, F.
Helms, O.
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Published in American Journal of Transplantation. 2010, vol. 10, no. 7, p. 1707-1712
Abstract 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.
Keywords AdolescentAdultAge of OnsetC-Peptide/bloodCombined Modality TherapyCystic Fibrosis/complications/ surgeryCystic Fibrosis Transmembrane Conductance Regulator/geneticsDiabetes Complications/surgeryForced Expiratory VolumeHumansIslets of Langerhans Transplantation/ methodsLung Transplantation/ methodsMaleMutationSequence DeletionTransplantation, HomologousTreatment OutcomeVital CapacityYoung Adult
Identifiers
PMID: 20642693
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Structures
Research groups Chirurgie viscérale (104)
La transplantation d'îlots de Langerhans (623)
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KESSLER, L. et al. Combined pancreatic islet-lung transplantation: a novel approach to the treatment of end-stage cystic fibrosis. In: American Journal of Transplantation, 2010, vol. 10, n° 7, p. 1707-1712. https://archive-ouverte.unige.ch/unige:21040

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Deposited on : 2012-05-23

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