title: Portal vein thrombosis is a potentially preventable complication in clinical islet transplantation.
abstract: Percutaneous transhepatic portal access avoids surgery but is rarely associated with bleeding or portal venous thrombosis (PVT). We herein report our large, single-center experience of percutaneous islet implantation and evaluate risk factors of PVT and graft function. Prospective data were collected on 268 intraportal islet transplants (122 subjects). A portal venous Doppler ultrasound was obtained on Days 1 and 7 posttransplant. Therapeutic heparinization, complete ablation of the portal catheter tract with Avitene paste and limiting packed cell volume (PCV) to <5 mL completely prevented any portal thrombosis in the most recent 101 islet transplant procedures over the past 5 years. In the previous cumulative experience, partial thrombosis did not affect islet function. Standard liver volume correlated negatively (r =-0.257, p < 0.001) and PCV correlated positively with portal pressure rise (r = 0.463, p < 0.001). Overall, partial portal thrombosis occurred after 10 procedures (overall incidence 3.7%, most recent 101 patient incidence 0%). There were no cases of complete thrombosis and no patient developed sequelae of portal hypertension. In conclusion, portal thrombosis is a preventable complication in clinical islet transplantation, provided therapeutic anticoagulation is maintained and PCV is limited to <5 mL.
authors: Department of aSurgery, University of Alberta, Edmonton, Alberta, Canada.
authors: T
authors: T
authors: Kawahara
authors: T
authors: T
authors: Kin
authors: S
authors: S
authors: Kashkoush
authors: B
authors: B
authors: Gala-Lopez
authors: D L
authors: DL
authors: Bigam
authors: N M
authors: NM
authors: Kneteman
authors: A
authors: A
authors: Koh
authors: P A
authors: PA
authors: Senior
authors: A M J
authors: AM
authors: Shapiro
mesh_terms: D002170:Canada / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D006801:Humans; D015994:Incidence; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D011169:Portal Vein / Q000503:physiopathology*; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*