Diabetes: A Historic Medical Advance

Rédigé le 22/10/2023
Jujue LV

The First Kidney-Pancreas Transplant from a Donor in Cardiac Arrest

This is the first time in France that a combined kidney-pancreas transplant has been performed after the organs have been removed following cardiorespiratory arrest. Dr Julien Branchereau, urological surgeon at Nantes University Hospital, performed the operation on a 36-year-old diabetic patient whose prognosis was vital.

What is diabetes?
Type 1 diabetes mellitus is a chronic disease characterized by abnormally high blood sugar levels (hyperglycemia).

The pancreas secretes insulin, which allows sugars to enter the body's cells. For diabetics, it's a failure of the pancreas that leads to insufficient insulin production and irregular blood sugar levels. As the pancreas no longer fulfils its role, insulin injections are used to regulate blood sugar levels.

If diabetes is poorly balanced, it can lead to serious complications (hypo- or hyper-glycemic comas, damage to nerves, kidneys, heart, arteries, etc.). Pancreas transplantation is the best treatment for very unbalanced diabetes.

What is the current situation?

Organ transplants are often performed on people who are brain-dead, i.e. when the brain no longer functions, but the heart continues to beat. In this situation, the organs continue to receive blood and oxygen, keeping them in good condition for transplantation.

However, when someone dies following cardiac arrest, the organs are no longer supplied with blood and can no longer be used for transplants, unless we intervene very quickly after death or develop a new preservation method.

Nantes University Hospital is at the cutting edge!

The CHU is playing a pioneering role in France by adopting a new technique approved by the Agence de la biomédecine. This involves maintaining blood circulation and oxygen supply in a part of the deceased's body, outside the body, in order to preserve organs for transplantation. This method restores the blood and oxygen supply to organs that have been deprived of these elements after the donor's cardiac arrest. This approach is used particularly for kidneys.

A total victory!

For this great first, the 36-year-old recipient patient was assisted by no less than thirty people. Resuscitators, coordinators, anaesthetists, nephrology (kidney) specialists and nurses worked around the young patient. He no longer needs insulin or dialysis. He will of course have to take anti-rejection treatment, but nothing compared to the suffering he endured, and Julien Branchereau adds, "he can live normally and even eat sugar″.

Dans les Bottes des Grands

Julien Branchereau situates his work in Nantes' medical history. He follows the trail blazed since 1986 by Diego Cantarovitch, who helped set up a pancreatic transplant program in Nantes back in 1987 with Jacques Paineau. Since then, the Nantes team has become one of the world's leading in this specific field, with around 20 pancreas transplants per year. He also cites Georges Karam, who led the project for 25 years, and Gilles Blancho, director of the Nantes Urology-Nephrology Transplant Institute. Nearly 650 patients have received pancreas transplants there, and over 6,000 kidney transplants.

Lack of donors

Performing this transplant requires a donor whose brain no longer functions, known as a brain-dead donor. However, finding such donors is becoming increasingly difficult, posing a challenge for doctors. Since 2014, Dr. Julien Branchereau (also a researcher at INSERM Unit 10 64 and Oxford University), and medical researchers at Nantes University Hospital have been working on a new idea to solve this problem.

One of the difficulties lies in the transplant context, as the pancreas is particularly sensitive to the absence of blood circulation, known as ischemia. In other words, the pancreas begins to degrade due to the lack of oxygen and eventually becomes damaged.

Following laboratory trials, Dr. Branchereau successfully performed France's first combined kidney and pancreas transplant, from a donor in cardiac arrest, on April 22, 2021. Following this success, the Nantes University Hospital performed a second transplant of this type. Dr. Branchereau is keen to keep up the momentum, as many people are waiting for a donor for these transplants. However, he notes that the number of organ donations is falling. He also notes a lack of public enthusiasm for the idea. He points out that, although it's impossible to donate a pancreas, it's quite possible to stay alive after giving a kidney to a brother or sister, for example.

In conclusion, it is undeniable that organ donation saves lives and offers a glimmer of hope to those waiting for a transplant. Medical advances, such as the preservation techniques developed by Nantes University Hospital, open up new opportunities for successful transplants, even in complex situations.

By considering organ donation, we can all make a remarkable difference. This simple decision can offer a chance of life to those in need, and bring hope to many.