Islet transplantation: outcome
Morbidity associated with intraportal islet transplantation

https://doi.org/10.1016/j.transproceed.2004.04.022Get rights and content

Abstract

Introduction

Complications associated with intraportal islet infusion have been reported. In this study, we analyzed the relationship between occurrence of complications and islet preparation characteristics/infusion technique.

Methods

We reviewed all intraportal islet infusions from 1992 to 2003.

Results

Sixteen islet autotransplantations were performed without infusion-related complications. The tissue volume injected was 13 ± 11 mL with basal and peak portal pressures of 13 ± 6 and 21 ± 6 mm Hg. Seventy-seven intraportal islet allotransplantations were performed in 51 patients. Fifteen islet infusions were done by laparotomy during simultaneous islet/kidney transplantation without complication. Among 62 percutaneous transhepatic injections, nine complications (two portal branch thrombosis and seven intra-abdominal hemorrhages) were recorded. Rise in portal pressure was related to tissue volume injected (P < .05). Basal and peak portal pressures were 14 ± 5 and 18 ± 6 mm Hg in uncomplicated infusions, 14 ± 9 and 18 ± 9 mm Hg in the thrombosis group, and 13 ± 7 and 18 ± 5 mm Hg in the hemorrhage group (P > .05). Complications occurred only after percutaneous islet infusion (P < .03).

Conclusions

Procedure-related morbidity of intraportal islet infusion is low. Changes in portal pressure are related to volume of tissue injected but do not seem to be associated with the occurrence of complications. Percutaneous infusion is a minimally invasive procedure, but this advantage must be balanced by the higher rate of complications.

Section snippets

Materials and methods

We reviewed all islet intraportal infusions performed either for auto- or allotransplantation from 1992 to 2003. Islet autotransplantation was performed with 16 islet infusions in 16 patients. The indications for pancreatectomy were insulinoma, benign cysts, or chronic pancreatitis. Islet allotransplantation included 77 islet infusions in 51 patients. Allotransplantation procedures in type I diabetic patients were performed either as simultaneous islet and kidney transplantations (SIK), as

Results

A linear correlation was observed between tissue volume infused and rise in portal pressure (R2 = .86). However, tissue volume infused and rise in portal pressure were not correlated with occurrence of complications. No complication was recorded with the open approach in 31 infusions, while nine complications (15%) occurred with the percutaneous approach in 62 infusions (P < .03).

Complications recorded were: three perihepatic hematomas, two partial portal branch thromboses, and four

Discussion

Previous authors have reported the effect of tissue volume on portal pressure increase during islet infusion.5 We have observed the same effect in our patients, but there was no correlation between volume of tissue infused and development of complications related to the procedure. In this study, the percutaneous approach was significantly associated with increased morbidity, namely bleeding and portal thrombosis. There is a possibility that the newly described technique of islet infusion using

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This work was funded by grant 32-061873.00 from the Swiss National Science Foundation.

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