Simultaneous liver-pancreas transplantation for cystic fibrosis-related liver disease: a multicenter experience
R H J Bandsma1, M A Bozic2, J A Fridell3
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, SickKids Transplant Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G1X8, Canada.
Insights
Simultaneous liver-pancreas transplantation may benefit cystic fibrosis patients with diabetes and liver disease. This procedure can restore pancreatic function and improve body mass index in select patients.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Endocrinology
Background:
- Diabetes mellitus increases morbidity and mortality in cystic fibrosis (CF) patients.
- While liver transplantation is established for CF-related liver disease (CFLD), the utility of simultaneous liver-pancreas transplantation remains unclear.
Purpose of the Study:
- To investigate the role and outcomes of simultaneous liver-pancreas transplantation in patients with CFLD and diabetes.
- To gather expert opinions on this procedure within pediatric transplantation centers.
Main Methods:
- A survey was distributed to 81 pediatric transplantation centers regarding simultaneous liver-pancreas transplantation for CFLD.
- Data on patient characteristics, transplant outcomes, and functional recovery were collected and analyzed.
Main Results:
- 94% of responding centers would consider simultaneous liver-pancreas transplantation for CFLD with diabetes.
- Eight patients underwent the procedure, with restored exocrine and endocrine pancreatic function in most.
- A significant increase in body mass index Z-score was observed post-transplantation.
Conclusions:
- Simultaneous liver-pancreas transplantation is a viable option for select CFLD patients with diabetes.
- Consideration of this combined transplant may improve outcomes for these complex patients.
Background:
Diabetes is associated with increased morbidity and mortality in patients with cystic fibrosis (CF). While liver transplantation is well established for CF-related liver disease (CFLD), the role of simultaneous liver-pancreas transplantation is less understood.
Methods:
We polled 81 pediatric transplantation centers to identify and characterize subjects who had undergone simultaneous liver-pancreas transplantation and obtain opinions about this procedure in CFLD.
Results:
Fifty (61.7%) polled transplant centers responded and 94% reported that they would consider simultaneous liver-pancreas transplantation for CFLD and diabetes. A total of 8 patients with simultaneous liver-pancreas transplantation were identified with median follow up of 38 months. All patients had pre-existing diabetes. Exocrine and endocrine pancreatic function was initially restored in all patients with later functional loss in one patient. Body mass index Z-score increased between one year pre-transplantation and one year post-transplantation (P=0.029).
Conclusions:
Patients with CFLD undergoing initial assessment for liver transplantation may benefit from consideration of simultaneous liver-pancreas transplantation.
