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

Am J Transplant. 2010 Jul;10(7):1707-12. doi: 10.1111/j.1600-6143.2010.03143.x.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • C-Peptide / blood
  • Combined Modality Therapy
  • Cystic Fibrosis / complications
  • Cystic Fibrosis / 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


  • C-Peptide
  • Cystic Fibrosis Transmembrane Conductance Regulator