Disseminated Intravascular Coagulation and Portal Hypertension Following Pancreatic Islet Autotransplantation

Abstract

A patient undergoing subtotal pancreatectomy and intraportal islet tissue autotransplantation for chronic pancreatitis developed severe portal hypertension (49 cm of H(2)O) and acute disseminated intravascular coagulation (DIC). In an attempt to identify the cause of these problems, portal pressure and the activities of the coagulation and fibrinolytic systems were studied in dogs undergoing intraportal autotransplantation of islet tissue. Following intraportal injection of the pancreatic tissue in five control dogs, the portal pressure rose to a maximum of 43.2 cm of H(2)O +/- 2.4 and major coagulation abnormalities occurred. The mean hematocrit value fell to 18% +/- 8.6, the mean platelet count to 218,000 +/- 31,000, the mean plasma fibrinogen to 40 mg/dl +/- 18, and the mean euglobulin clot lysis time (ECLT) to 25 min +/- 4. Partial thromboplastin time (PTT) became prolonged (233 secs +/- 30) and significant quantities of fibrinogen-fibrin degradation products (FDP-fdp) (1:128 +/- 32) appeared. These changes indicate the development of DIC probably secondary to significant amounts of tissue thromboplastin detected in the tissue homogenate infused at time of autotransplantation. In a group of seven dogs in whom heparin and Trasylol (aprotinin) were added to the pancreatic tissue at the time of transplantation, portal pressure rose only to a peak of 28.3 cm of H(2)O +/- 3.6 and no significant abnormalities occurred in mean hematocrit value, plasma fibrinogen, platelet count or ECLT. Minor prolongation of PTT occurred secondary to the activity of heparin. FDP-fdp (1:16) were present transiently during tissue injection. Four patients in whom heparin and Trasylol were added to the pancreatic tissue at the time of autotransplantation developed only minor elevations of portal pressure (mean 15.5 cm of H(2)O) without intravascular coagulopathy.

Evaluation of Viable β-Cell Mass is Useful for Selecting Collagenase for Human Islet Isolation: Comparison of Collagenase NB1 and Liberase HI

“…They demonstrated that total islet yields with no purification in both groups were similar, and that the percentage of embedded islets was significantly higher in the NB1 group compared to the Liberase group. The purification procedure is not always necessary for auto-islet transplantation unless the volume of whole islet preparation is high, which may increase the risk of intrahepatic thrombo-embolic events (31). However, in allogeneic islet transplantation, the purification process is a key for successful islet isolation and to reduce the volume of antigenic tissue implanted into the recipients.…”

Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis

“…Shortly after the initial report on IAT from the UMN more than 30 years ago (Sutherland et al, 1978), a few other centers also did IAT after total or partial pancreatectomy (Cameron et al, 1981;Fontana et al, 1994;Hinshaw et al, 2011;Mehigan et al, 1980;Mehigan et al, 1980;Memsic et al, 1984;Mirkovitch et al, 1981;Toledo-Pereyra et al, 1984;Traverso et al,1981) though because they were done without anticoagulation complications of the IAT occurred at some centers (Mehigan et al, 1980;Memsic et al, 1984;Toledo-Pereyra et al, 1984), but inexplicably not at others (Fontana et al, 1994;Hinshaw et al, 2011;Valente et al, 1986). Later several center began programs with low complication rates because of lessons learned from the others (Blondet et al, 2007).…”

Pancreas and islet transplantation

“…Dogs are particularly susceptible to the development of portal hypertension, and Kretschmer et al [183] found transplantation by this route not to be as effective as transplantation to the spleen. Mehigan et al [ 184] described disseminated intravascular coagulation and portal hypertension after intraportal transplantation. This syndrome was secondary to tissue thromboplastin in the preparation and could be prevented by prophylatic administration of heparin and aprotinin.…”