en
Scientific article
English

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

Published inAmerican journal of transplantation, vol. 10, no. 7, p. 1707-1712
Publication date2010
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
  • Adolescent
  • Adult
  • Age of Onset
  • C-Peptide/blood
  • Combined Modality Therapy
  • Cystic Fibrosis/complications/ surgery
  • Cystic Fibrosis Transmembrane Conductance Regulator/genetics
  • Diabetes Complications/surgery
  • Forced Expiratory Volume
  • Humans
  • Islets of Langerhans Transplantation/ methods
  • Lung Transplantation/ methods
  • Male
  • Mutation
  • Sequence Deletion
  • Transplantation, Homologous
  • Treatment Outcome
  • Vital Capacity
  • Young Adult
Citation (ISO format)
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. doi: 10.1111/j.1600-6143.2010.03143.x
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ISSN of the journal1600-6135
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