title: Percutaneous transhepatic pancreatic islet cell transplantation in type 1 diabetes mellitus: radiologic aspects.
abstract: OBJECTIVE
  To report our experience with percutaneous transhepatic pancreatic islet cell transplantation in patients with type 1 diabetes mellitus.
  
  
  METHODS
  Between March 1999 and May 2002, 34 patients underwent 68 islet cell transplantation procedures. Patients with C-peptide-negative type 1 diabetes were selected on the basis of poor metabolic control (hypoglycemia or lability) despite compliance with optimal medical therapy. Islet cells were isolated from brain-dead donors. Access to the portal vein was gained from a right percutaneous transhepatic approach, and islet cells were infused with intermittent pressure monitoring. Twenty patients underwent two transplantations, seven patients underwent three transplantations, and seven patients underwent one transplantation. Complications during and after the procedure and postprocedural diabetic status were monitored.
  
  
  RESULTS
  Successful portal vein cannulation and islet cell infusion were achieved in all cases. Fluoroscopy was used as the primary guidance modality in 58 of 68 (85%) procedures, and ultrasonography was used in 10 of 68 (15%). Total recorded fluoroscopy time varied from 0.6 to 103 minutes, with a median of 6.9 minutes. Potentially serious complications occurred in six of 68 (9%) procedures. Two patients developed portal venous thrombosis, and with subsequent anticoagulation therapy, one of the two developed an expanding hepatic hematoma that required surgery. Clinically important hemorrhage occurred in four patients, three of whom required blood transfusions. Of 26 patients who received completed transplants, all became insulin independent, and 81% (21 of 26) remained insulin free at 1 year.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Diagnostic Imaging, University of Alberta Hospital, 8440-112th Street, Edmonton, Alberta, Canada T6G 2B7. drrichardowen@shaw.ca
authors.forename: Richard J T
authors.initials: RJ
authors.lastname: Owen
authors.forename: Edmond A
authors.initials: EA
authors.lastname: Ryan
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Kelly
authors.forename: Jonathan R T
authors.initials: JR
authors.lastname: Lakey
authors.forename: Mairin C
authors.initials: MC
authors.lastname: McCarthy
authors.forename: Breay W
authors.initials: BW
authors.lastname: Paty
authors.forename: David L
authors.initials: DL
authors.lastname: Bigam
authors.forename: Norman M
authors.initials: NM
authors.lastname: Kneteman
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Korbutt
authors.forename: Ray V
authors.initials: RV
authors.lastname: Rajotte
authors.forename: A M James
authors.initials: AM
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D011677:Punctures / Q000009:adverse effects; D015641:Radiography, Interventional; D018084:Ultrasonography, Interventional