Radiologic aspects of islet cell transplantation

Neeman, Ziv; Hirshberg, Boaz; Harlan, David M.; Wood, Bradford J.

doi:10.1007/s11892-006-0066-z

Cited by 14 publications

(4 citation statements)

References 27 publications

(32 reference statements)

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“…Patients with known thrombophilia (protein C, S, anti-thrombin III, factor V Leiden deficiency) should not undergo percutaneous intraportal islet transplantation [87]. After brief skin infiltration with local anesthesia, and with ultrasonic guidance, a 22-gauge Chiba needle is advanced intraparenchymally until a peripheral branch of the right portal tree is identified [88][89][90][91][92][93]. An 18-gauge guidewire is then threaded in to the main portal vein and exchanged for a 4-5 French angio catheter (e.g.…”

Section: Intraportal Accessmentioning

confidence: 99%

Islet Transplantation in Type 1 Diabetes: Ongoing Challenges, Refined Procedures, and Long-Term Outcome

Shapiro¹

2012

Rev Diabet Stud

104

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Remarkable progress has been made in islet transplantation over a span of 40 years. Once just an experimental curiosity in mice, this therapy has moved forward, and can now provide robust therapy for highly selected patients with type 1 diabetes (T1D), refractory to stabilization by other means. This progress could not have occurred without extensive dynamic international collaboration. Currently, 1,085 patients have undergone islet transplantation at 40 international sites since the Edmonton Protocol was reported in 2000 (752 allografts, 333 autografts), according to the Collaborative Islet Transplant Registry. The long-term results of islet transplantation in selected centers now match registry data of pancreas-alone transplantation, with 6 sites reporting five-year insulin independence rates ≥50%. Islet transplantation has been criticized for the use of multiple donor pancreas organs, but progress has also occurred in single-donor success, with 10 sites reporting increased single-donor engraftment. The next wave of innovative clinical trial interventions will address instant blood-mediated inflammatory reaction (IBMIR), apoptosis, and inflammation, and will translate into further marked improvements in single-donor success. Effective control of auto- and alloimmunity is the key to long-term islet function, and high-resolution cellular and antibody-based assays will add considerable precision to this process. Advances in immunosuppression, with new antibody-based targeting of costimulatory blockade and other T-B cellular signaling, will have further profound impact on the safety record of immunotherapy. Clinical trials will move forward shortly to test out new human stem cell derived islets, and in parallel trials will move forward, testing pig islets for compatibility in patients. Induction of immunological tolerance to self-islet antigens and to allografts is a difficult challenge, but potentially within our grasp.

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Section: Intraportal Accessmentioning

confidence: 99%

Islet Transplantation in Type 1 Diabetes: Ongoing Challenges, Refined Procedures, and Long-Term Outcome

Shapiro¹

2012

Rev Diabet Stud

104

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“…Currently, the preferred transplantation site is the portal vein of the liver, which is not optimal due to venous hypoxemia and the potential risk of thrombosis. [95] Islet transplantation in the subcutaneous site would be more accessible and minimally invasive; however, the lack of early vascularization of the graft may result in loss of function and inability to restore normoglycemia due to poor graft oxygen supply. [96] [97–99]…”

Section: Mscs and T1dmentioning

confidence: 99%

Harnessing the Immunomodulatory and Tissue Repair Properties of Mesenchymal Stem Cells to Restore β Cell Function

2012

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Islet cell transplantation has therapeutic potential to cure type 1 diabetes (T1D), which is characterized by autoimmune-mediated destruction of insulin-producing β cells. However, current success rates are limited by long-term decline in islet graft function resulting partially from poor revascularization and immune destruction. MSCs have the potential to enhance islet transplantation and prevent disease progression by a multifaceted approach. MSCs have been shown to be effective at inhibiting inflammatory-mediated immune responses and at promoting tissue regeneration. The immunomodulatory and tissue repairing properties of MSCs may benefit β cell regeneration in the context of T1D. This review will elucidate how MSCs can minimize β cell damage by providing survival signals and simultaneously modulate the immune response by inhibiting activation and proliferation of several immune cell types. In addition, MSCs can enhance islet graft revascularization, maintaining long-term β cell viability and function.

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“…54 Reports have suggested 35 U/kg heparin if packed cell volume is <5 mL and 70 U/kg heparin if packed cell volume >5 mL. [55][56][57] On average, approximately 300,000 islet cells are obtained from purification of a single pancreas. 58 Compared with whole organ pancreas transplants, which require one donor per recipient, purification of enough islet cells for a single infusion typically requires two donors.…”

Section: Islet Cell Preparationmentioning

confidence: 99%

“…It can be diagnosed with ultrasound or contrast-enhanced CT scan, which may reveal filling defects in the portal veins and sequelae such as diffuse small bowel thickening. 55 A large prospective study performed by Kawahara et al found that portal vein thrombosis is preventable as long as therapeutic anticoagulation is started in the interventional radiology suite and maintained in the postprocedural setting (for at least 10 days) and packed cell volume is limited to less than 5 mL. 55,57 Treatment for portal vein thrombus is usually with systemic anticoagulation.…”

Section: Complicationsmentioning

confidence: 99%

Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

et al. 2019

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Pancreas transplantation is an exciting therapy which has been used for several decades in the treatment of diabetes mellitus. It can be performed as either a whole organ or islet cell transplant. The role of interventional radiologists in the management of whole organ transplants is evolving and includes treatment of postoperative complications and graft biopsy to evaluate for rejection. An in-depth understanding of the transplant anatomy and variations is a fundamental tool in performing these interventions successfully. Islet cell transplantation entails delivery of purified donor pancreatic islet cells into the recipient portal vein. Because of their expertise in image-guided access to the portal system, interventional radiologists play a crucial role in this procedure. The purpose of this article is to review the indications, anatomy, complications, and outcomes of both whole organ and islet cell pancreas transplants, followed by a discussion of the role of interventional radiologists in each procedure.

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Radiologic aspects of islet cell transplantation

Cited by 14 publications

References 27 publications

Islet Transplantation in Type 1 Diabetes: Ongoing Challenges, Refined Procedures, and Long-Term Outcome

Islet Transplantation in Type 1 Diabetes: Ongoing Challenges, Refined Procedures, and Long-Term Outcome

Harnessing the Immunomodulatory and Tissue Repair Properties of Mesenchymal Stem Cells to Restore β Cell Function

Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

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