Portal Vein Thrombosis Is a Potentially Preventable Complication in Clinical Islet Transplantation

Abstract

Percutaneous transhepatic portal access avoids surgery, but is rarely associated with bleeding or portal venous thrombosis. We herein report our large, single-center experience of percutaneous islet implantation, and evaluate risk factors of portal vein thrombosis and graft function. Prospective data was collected on 268 intraportal islet transplants (122 subjects). A portal venous Doppler ultrasound was obtained on Days 1 and 7 days posttransplant. Therapeutic heparinization, complete ablation of the portal catheter tract with Avitene paste, and limiting packed cell volume to < 5 ml completely prevented any portal thrombosis in the most recent 101 islet transplant procedures over the past 5 years. In the previous cumulative experience, partial thrombosis did not affect islet function. Standard liver volume correlated negatively (r=−0.257, P<0.001), and packed cell volume correlated positively with portal pressure rise (r=0.463, P<0.001). Overall, partial portal thrombosis occurred after 10 procedures (overall incidence 3.7%, most recent 101 patient incidence 0%). There were no cases of complete thrombosis, and no patient developed sequelae of portal hypertension. In conclusion, portal thrombosis is a preventable complication in clinical islet transplantation, provided therapeutic anticoagulation is maintained, and packed cell volume is limited to <5 ml.

Single-centre experience of extending indications for percutaneous intraportal islet autotransplantation (PIPIAT) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome

“…As previously reported, 34 and also in our series, a moderate increase of PVP was recorded after PIPIAT: this finding, often recorded after islet transplant, was already demonstrated to be strictly correlated to the number/volume of infused islets and the number of transplant procedures. 35 PVP increase is usually lower in autotransplantation than in allotransplantation, during which a higher islet mass is usually infused.…”

Trying to Prevent the Clogged Drain: Optimizing the Yield and Function of Portal Vein-Infused Islets

“…They also further investigated whether partial portal thrombosis was associated with detrimental loss of islet functional reserve. The incidence of portal thrombosis was low (3.2 %); despite partial portal thrombosis there was no detectable loss of islet graft function as measured by the SUITO index or insulin requirements [13,14]. Furthermore, Bucher et al [15] reported no association between portal thrombosis and increased IP pressure in islet autograft and allogeneic transplants when they limited the tissue volume infused to a mean of 13 cc [15].…”

“…A previous report from an international multicenter trial suggested that covert, underlying thrombophilic tendencies (protein C, S, antithrombin III, factor v Leiden deficiencies, or presence of antiphospholipid antibodies) may potentially exacerbate the risk of portal thrombosis after islet transplantation [12]. In a large, single-center prospective series of 268 consecutive IP islet allo-transplants conducted over 11 years, the Edmonton group recently reported their incidence of portal venous thrombosis [13]. Kawahara et al analyzed the contributory factors leading to partial thrombosis, including standard liver volume (SLV), packed cell volume, and acute portal pressure rise after islet transplantation, assuming that a smaller liver volume would be likely to have less capacity for embolized IP tissue.…”

Strategies in Preventing Diabetes after Pancreatectomy Using Islet Auto- and Allo-Transplantation

“…Intraportal islet infusion can trigger hepatic false aneurysm [60], portal vein thrombosis [61], and acute hepatic steatosis [62]. Recently, the intrahepatic location of islet transplantation has been suggested to be a potential cause for islet graft failure and increase in hypoglycemic incidence.…”