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Bilateral sequential lung and simultaneous pancreas transplant: a new approach for the recipient with cystic fibrosis
Jonathan A Fridell1, Thomas C Wozniak2, John M Reynolds2
1Indiana University School of Medicine, 550 N University BLVD, #4258, Indianapolis, Indiana 46202, USA.
Insights
Simultaneous lung and pancreas transplants offer a successful solution for cystic fibrosis (CF) patients with diabetes. This procedure eliminates the need for insulin, enzyme replacement, and supplemental oxygen, improving nutrition and overall health.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Pulmonology
Background:
- Cystic fibrosis (CF) is a genetic disorder causing multisystem complications, including pulmonary failure and pancreatic insufficiency.
- CF-related diabetes (CFRD) and exocrine insufficiency are common, necessitating insulin and enzyme supplementation.
- Malnutrition is prevalent in CF patients requiring advanced interventions.
Observation:
- This report details the first three simultaneous lung and pancreas transplantations in CF patients with CFRD.
- All patients had severe malnutrition and required nutritional support prior to transplantation.
- Surgical technique involved sequential bilateral lung transplantation followed by pancreas transplantation with enteric drainage.
Findings:
- Pancreas allografts functioned successfully, achieving normoglycemia without insulin dependence.
- Enteric drainage of the pancreas allograft rendered supplemental enzyme therapy unnecessary.
- Post-transplant, patients remained independent of supplemental oxygen, insulin, and pancreatic enzymes at follow-up intervals of 4, 6, and 14 months.
Implications:
- Simultaneous lung and pancreas transplantation is a viable option for select CF patients.
- The procedure offers significant benefits, including improved glycemic control and nutritional status.
- Successful transplantation can enhance the quality of life for CF patients with complex comorbidities.
Unlabelled:
Cystic fibrosis (CF) is an inherited disorder that presents in childhood as a multisystem disease. Pulmonary failure and pancreatic insufficiency, including CF related diabetes (CFRD) and exocrine insufficiency, are common complications of this disease. In this report we review the first three simultaneous lung and pancreas transplantations in CF patients with diabetes.
Methods:
All three CF patients presented for evaluation for lung transplantation and had pancreatic insufficiency requiring enzyme supplementation and CFRD requiring insulin. All were severely malnourished and required nutritional supplementation.
Surgical Technique:
In each case, the allografts were procured from a single cadaveric donor. Bilateral lung transplantation was performed first using two separate thoracic incisions. The pancreas transplant was performed with systemic venous drainage and enteric exocrine drainage.
Results:
The pancreas allografts all functioned normally with normoglycemia independent of insulin. As a result of the enteric drainage of the pancreas allograft, supplemental pancreatic enzymes were no longer required. Despite several complications detailed in the manuscript, all three remain independent of supplemental oxygen, insulin and pancreatic enzyme replacement at 4, 6 and 14 months of follow-up.
Conclusion:
Simultaneous lung and pancreas transplantation in patients with CF can be performed successfully and provides the advantages of normoglycemia and improves nutrition for patients requiring lung transplantation.
