Portal venous pressure changes after sequential clinical islet transplantation.
BACKGROUND
Sequential pancreatic islet transplantation via the portal vein has led to insulin independence in patients with type 1 diabetes. Complications associated with the injection of islets into the portal vein have been reported; therefore, in this study we sought to further characterize changes in portal venous pressure associated with islet infusion.


METHODS
Pre- and posttransplant portal venous pressures were recorded in 50 consecutive transplant procedures in 26 patients receiving highly purified, heparinized allogeneic islet preparations via a radiologically placed portal venous cannula. Doppler ultrasound scans of the portal vein were completed within 24 hr of transplantation.


RESULTS
Posttransplant portal vein pressures rose significantly with sequential transplantation (12.4 mm Hg vs. 17.3 mm Hg, P <0.05). Portal pressure change correlated significantly with islet packed cell volume (r =0.66, P <0.001) and also with the number of islets transplanted ( r=0.49, P <0.001). Segmental portal vein thrombosis was radiologically detected after two procedures (4%).


CONCLUSIONS
Multiple sequential islet transplants can be safely performed via the portal vein, provided that care is taken with islet purification and attention is paid to portal venous monitoring.
Casey
John J
JJ
Department of Surgical and Clinical Sciences (Surgery), Royal Infirmary, Edinburgh, Scotland.
Lakey
Jonathan R
JR
Ryan
Edmond A
EA
Paty
Breay W
BW
Owen
Richard
R
O'Kelly
Kevin
K
Nanji
Sulaiman
S
Rajotte
Ray V
RV
Korbutt
Gregory S
GS
Bigam
David
D
Kneteman
Norman N
NN
Shapiro
A M
AM
D006801:Humans; D007275:Injections, Intravenous; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000379:methods; D011169:Portal Vein / Q000503:physiopathology*; D011184:Postoperative Period; D014690:Venous Pressure; D020246:Venous Thrombosis / Q000209:etiology