Article: article from journal or magazin.
Case report (case report): feedback on an observation with a short commentary.
Combined islet-lung transplantation in a cystic fibrosis patient.
Schweizerische Medizinische Wochenschrift. Supplementum
Publication types: Case Reports ; Journal Article
The prevalence of insulin-dependent diabetes mellitus (IDDM) in cystic fibrosis patients ranges from 2 to 8% and glucose intolerance up to 15%. In recent years, lung transplantation has helped to prolong life expectancy of cystic fibrosis patients and represents 10 to 30% of all indications for lung transplantation. The postoperative need for immunosuppressive therapy using diabetogenic agents has decompensatory effects on glucose regulation and will probably increase the number of insulin-dependent cystic fibrosis patients. We report the case of an insulin-dependent cystic fibrosis patient transplanted with a combined islet-lung allograft. The pre-transplantation C-peptide level was below 0.04 nmol/l and preoperative insulin requirement was some 100 U per day. A sequential bipulmonary lung transplantation was performed and, using the pancreas of the same donor, we isolated and purified the islets of Langerhans by a modified automated method. We obtained 232,200 islets equivalent, which were injected into the liver by portal embolization. The postoperative course was uncomplicated, the insulin requirement decreased to 50% of the preoperative need and the C-peptide value increased to normal values and remained with the normal range during a follow-up period of 15 months. In conclusion, we believe that, besides type I diabetic patients, insulin-dependent cystic fibrosis patients with a negative C-peptide value could also be good candidates for combined islet-lung allotransplantation.
Adult, Cystic Fibrosis/complications, Cystic Fibrosis/surgery, Diabetes Mellitus, Type 1/complications, Diabetes Mellitus, Type 1/surgery, Drug Therapy, Combination, Humans, Immunosuppressive Agents/administration & dosage, Islets of Langerhans Transplantation/methods, Lung Transplantation/methods, Male
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