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Published online before print August 27, 2003, 10.1148/radiol.2291021632

(Radiology 2003;229:165.)

A more recent version of this article appeared on October 1, 2003
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© RSNA, 2003

Vascular and Interventional Radiology

Percutaneous Transhepatic Pancreatic Islet Cell Transplantation in Type 1 Diabetes Mellitus: Radiologic Aspects1

Richard J. T. Owen, MB, Edmond A. Ryan, MD, Kevin O’Kelly, MB, Jonathan R. T. Lakey, PhD, Mairin C. McCarthy, MB, Breay W. Paty, MD, David L. Bigam, MD, Norman M. Kneteman, MD, Gregory S. Korbutt, PhD, Ray V. Rajotte, PhD and A. M. James Shapiro, MD, PhD

1 From the Departments of Diagnostic Imaging (R.J.T.O., K.O., M.C.M.), Medicine (E.A.R., B.W.P.), and Surgery (D.L.B.) and the Surgical-Medical Research Institute and Clinical Islet Transplant Program (J.R.T.L., N.M.K., G.S.K., R.V.R., A.M.J.S.), University of Alberta Hospital, 8440 - 112th St, Edmonton, Alberta, Canada T6G 2B7. Received December 2, 2002; revision requested January 30, 2003; revision received February 21; accepted April 11. Supported by a clinical centre grant from the Juvenile Diabetes Research Foundation, the Alberta Foundation for Diabetes Research, a donation from the Roberts family, a grant from the Canadian Institute for Health Research, the Alberta Health Services Innovation Fund, and institutional support by the University of Alberta Hospitals, Capital Health, and Province Wide Services of the Government of Alberta. Address correspondence to R.J.T.O. (e-mail: drrichardowen@shaw.ca).

PURPOSE: To report our experience with percutaneous transhepatic pancreatic islet cell transplantation in patients with type 1 diabetes mellitus.

MATERIALS AND 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.

CONCLUSION: 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.

© RSNA, 2003

Index terms: Diabetes mellitus • Interventional procedures, complications, 957.1264, 947.442 • Pancreas, transplantation, 770.1267 • Portal vein, therapeutic embolization, 957.1264




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