Simultaneous liver and pancreas transplantation in patients with cystic fibrosis

J. A. Fridell, R. Vianna, P. Y. Kwo, Michelle Howenstine, A. Sannuti, Jean Molleston, M. D. Pescovitz, A. J. Tector

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background. Improved survival in patients with cystic fibrosis (CF) has led to an increased incidence of extrapulmonary complications of this disease. Of these, cirrhosis and pancreatic insufficiency, including CF-related diabetes (CFRD) and exocrine insufficiency, are significant causes of morbidity and mortality. Liver transplantation is the treatment of choice for cirrhosis in this setting, but the addition of an isolated simultaneous pancreas transplant in patients with CFRD has not been reported. Methods. Two female patients with CF underwent simultaneous pancreas and liver transplantation. Both had pancreatic insufficiency, CFRD, cirrhosis, and preserved renal function. In each case, the liver and pancreas were procured from a single cadaveric donor. The liver transplant was performed first. A lower midline extension was added for improved exposure of the iliac vessels. The donor pancreas transplant was performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included rabbit anti-thymocyte globulin, tacrolimus, mycophenolate mofetil, and early steroid withdrawal. Results. Both patients recovered well with normal liver function, resolution of portal hypertension, and normal blood glucoses independent of insulin. As a result of the enteric exocrine drainage of the pancreas, they are now independent of supplemental pancreatic enzymes. Conclusions. Simultaneous liver and pancreas transplantation in CF patients provides the advantages of normalization of glucose and improved nutrition for patients requiring liver transplantation and should be considered in CF patients with CFRD who require liver transplants.

Original languageEnglish
Pages (from-to)3567-3569
Number of pages3
JournalTransplantation Proceedings
Volume37
Issue number8
DOIs
StatePublished - Oct 2005

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Pancreas Transplantation
Cystic Fibrosis
Liver Transplantation
Exocrine Pancreatic Insufficiency
Transplants
Drainage
Pancreas
Fibrosis
Liver
Tissue Donors
Mycophenolic Acid
Exocrine Pancreas
Antilymphocyte Serum
Portal Hypertension
Tacrolimus
Immunosuppression
Blood Glucose
Steroids
Insulin
Rabbits

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Simultaneous liver and pancreas transplantation in patients with cystic fibrosis. / Fridell, J. A.; Vianna, R.; Kwo, P. Y.; Howenstine, Michelle; Sannuti, A.; Molleston, Jean; Pescovitz, M. D.; Tector, A. J.

In: Transplantation Proceedings, Vol. 37, No. 8, 10.2005, p. 3567-3569.

Research output: Contribution to journalArticle

Fridell, J. A. ; Vianna, R. ; Kwo, P. Y. ; Howenstine, Michelle ; Sannuti, A. ; Molleston, Jean ; Pescovitz, M. D. ; Tector, A. J. / Simultaneous liver and pancreas transplantation in patients with cystic fibrosis. In: Transplantation Proceedings. 2005 ; Vol. 37, No. 8. pp. 3567-3569.
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