Percutaneous transhepatic pancreatic islet cell transplantation in type 1 diabetes mellitus: radiologic aspects.
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.
Owen
Richard J T
RJ
Departments of Diagnostic Imaging, University of Alberta Hospital, 8440-112th Street, Edmonton, Alberta, Canada T6G 2B7. drrichardowen@shaw.ca
Ryan
Edmond A
EA
O'Kelly
Kevin
K
Lakey
Jonathan R T
JR
McCarthy
Mairin C
MC
Paty
Breay W
BW
Bigam
David L
DL
Kneteman
Norman M
NM
Korbutt
Gregory S
GS
Rajotte
Ray V
RV
Shapiro
A M James
AM
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