Technique, complications, and therapeutic efficacy of percutaneous transplantation of human pancreatic islet cells in type 1 diabetes: the role of US.
OBJECTIVE
To retrospectively evaluate the role of ultrasonography (US) with regard to the technique, complications, and therapeutic efficacy of percutaneous intrahepatic transplantation of human pancreatic islet cells with combined US and fluoroscopic guidance.


METHODS
The institutional review board approved the study, and informed consent was obtained from all patients. After kidney transplantation, 34 uremic diabetic patients (20 men, 14 women; mean age, 40.9 years; age range, 29-61 years) underwent percutaneous intrahepatic transplantation of islet cells. Portal vein patency and liver echotexture were preliminarily assessed with color Doppler US. US also was used to identify early complications and presence (group A patients) or absence (group B patients) of hepatic parenchymal changes. Differences between the two groups in C peptide serum level and range were analyzed (Mann-Whitney test). Therapeutic efficacy of transplantation was assessed with regard to insulin independence period (rate and duration), exogenous insulin requirement, glycated hemoglobin, and C peptide level. A C peptide level of more than 0.5 ng/mL was considered to indicate well-functioning islet cells.


RESULTS
Fifty-eight procedures were technically successful, with a single puncture used in 51 of 58 patients. Complications occurred in three of 58 patients (hemoperitoneum, hemothorax, and thrombosis in one patient each) and were conservatively treated and resolved. Duration of insulin independence in 12 patients was more than 3 months (mean, 21 months). Well-functioning islet cells at 6 years were found in 19 of 34 patients. Hyperechoic parenchymal changes were evident at US in 12 of 34. No statistically significant difference in C peptide level was found between groups (P > .05), but a wider range of values was recorded in group B.


CONCLUSIONS
Complication rate of transplantation with US and fluoroscopic guidance was low. Well-functioning islet cells were found in about 50% of patients at 6 years of follow-up. Hepatic implantation of islet cells was evident on US images in more than one-third of patients.
Venturini
Massimo
M
Department of Radiology, San Raffaele Scientific Institute, Vita-Salute University, Olgettina 60, 20132 Milan, Italy. venturini.massimo@hsr.it
Angeli
Enzo
E
Maffi
Paola
P
Fiorina
Paolo
P
Bertuzzi
Federico
F
Salvioni
Marco
M
De Cobelli
Francesco
F
Socci
Carlo
C
Aldrighetti
Luca
L
Losio
Claudio
C
Di Carlo
Valerio
V
Secchi
Antonio
A
Del Maschio
Alessandro
A
D000328:Adult; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006455:Hemoglobins, Abnormal / Q000032:analysis; D006801:Humans; D007165:Immunosuppression Therapy; D007328:Insulin / Q000008:administration & dosage; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D002096:C-Peptide; D006455:Hemoglobins, Abnormal; D007328:Insulin; C048900:hemoglobin, glycerated