Percutaneous Transhepatic Pancreatic Islet Cell Transplantation in Type 1 Diabetes Mellitus: Radiologic Aspects

Abstract

The percutaneous transhepatic approach for the implantation of islet cells into the portal vein is a safe procedure, and together with use of current cell separation techniques and an immunosuppressive regimen, offers a marked advance in the treatment of type 1 diabetes mellitus.

Sequential Kidney/Islet Transplantation: Efficacy and Safety Assessment of a Steroid-Free Immunosuppression Protocol

“…One of the patients with bleeding had a factor V Leiden mutation and had required prompt anticoagulation after transplantation. In order to reduce bleeding risks after islet transplantation, patients with coagulopathy should be excluded, only careful postinjection anticoagulation prophylaxis should be given, only small catheter should be used (≤4.5 French) and the radiologist should be experienced to prevent repeated punctures (35,36). We did not record any thrombosis, although some islet preparations had low purity and some patients had significant but transient increases in postinfusion portal pressure.…”

Embolization of percutaneous transhepatic portal venous access tract withN-butyl cyanoacrylate

“…[1][2][3][4][5][6] After performing these procedures, life-threatening bleeding may occur from transhepatic tracts and, as a result, lead to morbidity and mortality. According to the literature, various embolic materials, including gelatin sponge particles, biological tissue adhesives, coils and plugs, have been utilized to prevent bleeding from the tracts.…”

Radiologic aspects of islet cell transplantation

“…However, the technique requires continued optimization and refinement to decrease risks, and there remains a significant incidence of postprocedural complications [6][7][8].…”

“…The past decade has witnessed the publication of multiple papers describing the islet cell transplantation experience at different centers addressing various procedural aspects, including complications [6][7][8], prevention of complications (bleeding) [9,10], technical aspects [11], current indications [12], progress and challenge [13], future opportunities [14], benefits and success [2,15•], follow-up, and clinical outcomes [15•]. Only two papers describing several centers' radiology role using the percutaneous-transhepatic intraportal technique have been published [16,17].…”

“…Owen et al [8] reported their procedure-related complication experience for 68 islet cell transplantation procedures performed on 34 patients between March 199.9 and May 2002. Potentially serious complications occurred in six of 68 (9%) procedures: two patients developed portal vein thrombosis and were treated with anticoagulation therapy; in one patient, this led to an expanding hepatic hematoma that required surgery.…”