Thanks to this innovative strategy, a patient previously condemned to chronic dialysis could regain lasting glycemic balance and a life free from major therapeutic constraints. Progress made possible by the mobilization of highly specialized medical teams… and by the generosity of a donor.
A national first in the heart of Toulouse’s operating theaters
In the operating rooms of the Toulouse University Hospital, the tension was palpable. Surgeons, nephrologists, diabetologists, interventional radiologists: everyone knew that they were participating in an extraordinary intervention. The transplant teams carried out for the first time in France a simultaneous transplant of a kidney and pancreatic islets from the same donor known as “Maastricht 3”.
This category of donor corresponds to people who died after cardiac arrest following a decision to stop treatment. Unlike brain-dead donors, the organs and cells are then deprived of blood circulation for a certain period of time after death, which considerably complicates their collection and conservation.
In this context, successfully using a single donor for two complementary transplants represents a major logistical and medical challenge. Every minute counts, every gesture is meticulous, every coordination between teams becomes decisive.
The feat is all the more remarkable as it combines two distinct procedures: the transplantation of a kidney and that of pancreatic islets, these tiny structures of the pancreas capable of producing the insulin essential for regulating blood sugar.
A patient with a particularly complex medical journey
Behind the technical feat, there is first and foremost a human story. That of a patient who had suffered from type 1 diabetes for many years, whose disease had progressively led to chronic renal failure at an advanced stage. Like many in this situation, he had depended on dialysis for several years to survive.
Usually, patients with both severe type 1 diabetes and kidney failure can benefit from a combined kidney-pancreas transplant. But in this specific case, intervention was impossible.
The patient actually presented significant vascular constraints which made this option too risky. The medical teams therefore imagined an alternative strategy: combining a classic kidney transplant with a transplant of islets of Langerhans – the pancreatic cells which produce insulin.
These cells, destroyed by the immune system in people with type 1 diabetes, can be isolated from a donor pancreas and then transplanted into the recipient’s body, usually in the liver, where they begin producing insulin again.
In this configuration, the kidney transplant makes it possible to stop dialysis, while the islet transplant aims to stabilize blood sugar levels in the long term. An essential metabolic balance, in particular to protect the new kidney from the risk of recurrence of diabetes on the graft.
Today, the patient no longer needs dialysis and now produces part of his own insulin, which reduces his injections and stabilizes his blood sugar level.
A breakthrough that opens up new perspectives for patients
In recent years, pancreatic islet transplantation has been progressing in France. It has been routinely authorized since April 2021, but its deployment remains gradual and requires highly specialized teams. At Toulouse University Hospital, this activity began in 2025. It is part of an increasingly personalized approach to the management of type 1 diabetes, which takes into account the overall clinical situation of patients.
As explained by Dr Laure Esposito, nephrologist at Rangueil Hospital, Toulouse University Hospital, involved in this intervention:
“Since the authorization of routine islet transplantation in France in April 2021, and at Toulouse University Hospital in 2025, several therapies to improve the care of type 1 diabetic patients allow personalized care according to the needs and comorbidities of patients, islet transplantation alone, islet transplants after kidney transplant and simultaneous islet kidney transplant. These open up prospects for better patient survival, nephroprotection through the glycemic balance obtained and improvement in the quality of life for these patients in the long term. A hope of recovery thanks above all to donors, but also thanks to the shared or associated feats of teams of passionate caregivers! Allowing patients to no longer be dialyzed and no longer diabetic is truly a wonder and daily satisfaction. Thank you to the TREPID group which enables its collective progress”.
This advance obviously remains a step in a constantly evolving scientific process. Pancreatic islet transplantation is not yet a solution for all diabetic patients, and it still requires immunosuppressive treatment to avoid rejection. But for certain complex situations, such as the one encountered in Toulouse, it opens up a previously inaccessible therapeutic avenue.
And behind this progress, there is always the same invisible chain of solidarity: that of donors and their loved ones. Without them, none of these medical victories would be possible.