Insulin independence achieved using the transmesenteric approach to the portal vein for islet transplantation.
Clinical human islet transplantation has been performed successfully using a percutaneous transhepatic approach to access the portal vein. The risks from percutaneous delivery of islets, such as bleeding and puncturing neighboring structures, can be avoided by a transmesenteric approach to the portal vein, which we have used to stent completely or near-completely occluded portal veins in both cirrhotic and noncirrhotic patients with minimum morbidity. After minilaparotomy, a second-order tributary branch of the mesenteric vein is cannulated to provide endovascular access to the portal vein. The islet preparation is infused through a catheter directed under fluoroscopy from the mesenteric vein to the portal vein. Pre- and postinfusion portograms are obtained to confirm the absence of any interval changes in portal venous flow. We have performed this procedure successfully in three islet-transplant recipients each receiving two infusions on separate occasions, with some of these procedures performed under local anesthesia without complications. The transmesenteric approach promises to be a safe alternative to percutaneous islet delivery.
Osama Gaber
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Department of Surgery, Division of Transplantation, University of Tennessee Health Science Center, Memphis, TN 38163, USA. agaber@utmem.edu
Chamsuddin
Abbas
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Fraga
Daniel
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Fisher
Jonathan
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Lo
Agnes
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D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods* / Q000502:physiology; D008642:Mesenteric Veins / Q000601:surgery*; D011169:Portal Vein / Q000601:surgery*
D001786:Blood Glucose