Bühler L, Andereggen E, Deng S, Spiliopoulos A, Nicod L, Rochat T, Tschopp J M, Cretin N, Fournier B, Conrad B, Mentha G, Morel P
Clinique de chirurgie digestive, Hôpital cantonal universitaire de Genève.
Schweiz Med Wochenschr Suppl. 1996;79:73S-75S.
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.
胰岛素依赖型糖尿病（IDDM）在囊性纤维化患者中的患病率为2%至8%，葡萄糖耐量异常者高达15%。近年来，肺移植有助于延长囊性纤维化患者的预期寿命，占所有肺移植指征的10%至30%。术后使用致糖尿病药物进行免疫抑制治疗对血糖调节有代偿失调作用，可能会增加胰岛素依赖型囊性纤维化患者的数量。我们报告了一例接受胰岛-肺联合移植的胰岛素依赖型囊性纤维化患者的病例。移植前C肽水平低于0.04 nmol/l，术前胰岛素需求量约为每天100 U。进行了序贯双肺移植，并使用同一供体的胰腺，通过改良的自动化方法分离和纯化了胰岛。我们获得了232,200个胰岛当量，通过门静脉栓塞将其注入肝脏。术后过程顺利，胰岛素需求量降至术前需求的50%，C肽值升至正常水平，并在15个月的随访期内保持在正常范围内。总之，我们认为，除了I型糖尿病患者外，C肽值为阴性的胰岛素依赖型囊性纤维化患者也可能是胰岛-肺联合异体移植的良好候选者。
