Towards a new solution for patients with severe type 1 diabetes which impairs renal function? For the first time in France, the Hospices Civils de Lyon carried out last August the simultaneous transplant of a kidney and pancreatic islets, known as “Langerhans islets”, on the same patient and from the same donor.
After five months of convalescence, “ the patient is on the way to being permanently cured of his diabetes », Underlines the Lyon hospital institution in mid-January, which has since repeated this operation twice, with success.
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Consisting of the transplantation of a kidney, then the injection of islets from the Pancreas – whose endocrine cells produce insulin – into the liver, less than 48 hours after the operation, this medical advance responds to patients with complicated type 1 diabetes, in a phase of severe renal failure. Or one in 1,000 people with diabetes type 1 in France, according to Public Health France, which lists around 200,000 patients in France.
The continuation of a twenty-year experimental protocol
Above all, this operation adds a brick to the only pancreatic islet transplant, which has been practiced for around twenty years in France, until then ” only for experimental purposes, as part of clinical research protocols », Indicate the HCL. Since 2023, this transplant has now been authorized by the High Authority of Health in six French university hospitals: Lyon, Grenoble, Paris, Lille, Strasbourg and Montpellier.
Around thirty islet injections have been undertaken at the Lyon Edouard Herriot hospital over the last two years, including 18 in 2024 alone. They concerned patients with type 1 diabetes, but also rare types of diabetes, called “monogenic”. Diabetic patients with cystic fibrosis, or who have undergone a total pancreatectomy for chronic pancreatitis, can also benefit from it.
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Without islet transplantation, some patients could previously (and still can) receive a whole pancreas transplant. And this, “ with very good functional results », Underlines Professor Thierry Berney, head of the Langerhans islet transplantation program at the Hospices Civils de Lyon. Who adds:
« However, this is a major surgical procedure, which fragile, elderly patients or patients suffering from significant heart or lung problems would not be able to tolerate. »
Moreover, ” the development of blood glucose sensors and/or insulin pumps offers diabetic patients therapeutic means that have become very effective, which make it possible to control diabetes better than before », continues the professor.
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Several laboratories, including Sanofi, are working on these issues. The latter notably bought last year for 2.9 billion dollars the biomedicine Tzeild, currently only marketed in the United States and which helps slow the appearance of symptoms of type 1 diabetes. The French laboratory has announced in November that it wanted to repatriate production to a new unit located on its Lyon Gerland site, for marketing targeted in 2027.
A solution that would only address some of the patients. The registry comes here to respond “ to patients for whom these new technologies fail to prevent the development of complicated diabetes », adds Professor Thierry Berney.
A laboratory soon to be developed with Geneva
The double operation with the kidney transplant, for its part unprecedented, allows according to the HCL “ taking a further step “. On the one hand on the medical level, since “ having grafts from the same donor facilitates acceptance by the body », Specifies Doctor Fanny Buron, hospital practitioner. But also by reducing hospitalization times, since the transplant is carried out in one go rather than in two. “ This avoids double surgery for the patient and saves them several months of convalescence. »
« There are currently 28 patients on the waiting list in Lyon for an islet transplant (including 9 waiting for a simultaneous kidney-islet transplant). Other patients are undergoing pre-transplant assessment », adds the CHU.
The Lyon university hospital center adds that “ this objective should be facilitated by the upcoming development, in collaboration with the University Hospitals of Geneva (HUG), of a pancreatic islet isolation laboratory within the Edouard Herriot hospital itself. », the financing and exact schedule of which have not yet been revealed.
