Allo- and auto-percutaneous intra-portal pancreatic islet transplantation (PIPIT) for diabetes cure and prevention: the role of imaging and interventional radiology

Abstract

Although the life expectancy of patients with type 1 diabetes mellitus (T1DM) has improved since the introduction of insulin therapy, the acute life-threatening and long-term complications from diabetes mellitus are significant causes of both mortality and morbidity. Percutaneous intra-portal pancreatic islet transplantation (PIPIT) is a minimally invasive, repeatable procedure which allows a β-cell replacement therapy through a liver islet engraftment, leading to insulin release and glycaemic control restoration in patients with diabetes. Allo-PIPIT, in which isolated and purified islets from cadaveric donor are used, does not require major surgery, and is potentially less expensive for the recipient. In case of long-term T1DM, islet-after-kidney (IAK) transplantation can simultaneously cure diabetes and chronic renal failure, while islet-transplant-alone (ITA) is performed in brittle, short-term T1DM, based on the infusion of an adequate islet mass and on a steroid-free immunosuppressive regimen according to the Edmonton protocol. Results of the Collaborative Islet Transplant Registry (CITR) demonstrate that allo-PIPIT reduces episodes of hypoglycemia and diabetic complications, and improves quality of life of diabetic patients. Auto-PIPIT, in which the own patient's islets are used, has been investigated as a preventive treatment for pancreatogenic diabetes in patients who undergo extensive pancreatectomy for malignant and non-malignant disease. This Review outlines the role of imaging and interventional radiology in allo- and auto-PIPIT.

Embolisation of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centres

“…Furthermore, they normally receive perioperative anticoagulation. On the contrary, patients undergoing pancreatic islet transplantation rarely suffer from portal hypertension and the portal pressure increase after islet injection is negligible (Venturini et al 2018 ); moreover, they do not receive perioperative anticoagulation. In liver transplanted patients with portal vein obstruction the introducer sheath ranges up to 7F while in pancreatic islet transplanted patients it is 4F at maximum.…”

“…The indications for percutaneous portal vein catheterization (PPVC) have significantly grown in recent years, due to technical developments of interventional radiology and organ transplantation (Saad and Madoff 2012 ; Ohm et al 2017 ). Transhepatic and transplenic portal vein accesses are mainly performed to manage complications of liver transplant, such as stenosis and thrombosis, to induce liver hypertrophy before major resections, with portal vein embolisation, and to administer autologous or heterologous cells in the setting of pancreatic islet transplantation (Saad and Madoff 2012 ; Denys et al 2012 ; Venturini et al 2018 ). Although the issue of haemostasis is considered less relevant during portal vein embolisation with the ipsilateral approach (Saad and Madoff 2012 ), the embolisation of the parenchymal tract should be regarded as a key step after any other transhepatic or transplenic PPVC, since eventual venous bleeding is difficult to control and may require surgical management.…”

Embolization of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centers.

“…Furthermore, they normally receive perioperative anticoagulation. On the contrary, patients undergoing pancreatic islet transplantation rarely suffer from portal hypertension and the portal pressure increase after islet injection is negligible [4]; moreover, they do not receive perioperative anticoagulation.…”

“…The indications for percutaneous portal vein catheterization (PPVC) have signi cantly grown in recent years, due to technical developments of interventional radiology and organ transplantation [1,2]. Transhepatic and transplenic portal vein accesses are mainly performed to manage complications of liver transplant, such as stenosis and thrombosis, to induce liver hypertrophy before major resections, with portal vein embolization, and to administer autologous or heterologous cells in the setting of pancreatic islet transplantation [1,3,4]. Although the issue of hemostasis is considered less relevant during portal vein embolization with the ipsilateral approach [1], the embolization of the parenchymal tract should be regarded as a key step after any other transhepatic or transplenic PPVC, since eventual venous bleeding is di cult to control and may require surgical management.…”

Interventional radiology of glands

“…A new frontiers of IR applications in endocrine setting are the treatments of endocrine diseases such as the pancreatic islet percutaneous transplantation (9) and the adrenal glands IR treatments (10).…”