Pancreatic Islet Transplantation

Goss, John A.; Soltes, George D.; Goodpastor, Sarah E.; Barth, M.; Lam, Russell C.; Brunicardi, F. Charles; Froud, Tatiana; Alejandro, Rodolfo; Ricordi, Camillo

doi:10.1097/01.tp.0000073976.26604.96

Cited by 74 publications

(54 citation statements)

References 28 publications

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“…Percutaneous access to the portal vein was carried out in the interventional radiology suite using ultrasonic and/or fluoroscopic guidance, as described previously (12,13,17). Briefly, portal vein access was gained using a 22 gauge Chiba needle and exchanged over a 0.018 inch guidewire for a 4 Fr catheter (stiffened micropuncture introducer set, Cook Inc., Bloomington, IN) (12).…”

Section: Methodsmentioning

confidence: 99%

“…Although some islet centers have elected to use an open surgical approach to avoid procedure-related bleeding (11), most centers have adopted the percutaneous transhepatic route for islet implantation to avoid a need for surgery (12,13). Life-threatening acute bleeds have been reported in islet recipients following the percutaneous approach (14)(15)(16) and this serious complication is potentially avoidable by obliteration of the intrahepatic portal catheter track.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of Bleeding After Islet Transplantation: Lessons Learned from a Multivariate Analysis of 132 Cases at a Single Institution

Villiger

Ryan

Owen

et al. 2005

American Journal of Transplantation

154

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Islet transplantation is being offered increasingly for selected patients with unstable type 1 diabetes. Percutaneous transhepatic portal access avoids a need for surgery, but is associated with potential risk of bleeding. Between 1999 and 2005, we performed 132 percutaneous transhepatic islet transplants in 67 patients. We encountered bleeding in 18/132 cases (13.6%). In univariate analysis, the risk of bleeding in the absence of effective track ablation was associated with an increasing number of procedures (2nd and 3rd procedures with an odds ratio (OR) of 9.5 and 20.9, respectively), platelets count <150 000 (OR 4.4), elevated portal pressure (OR 1.1 per mm Hg rise), heparin dose ≥45 U/kg (OR 9.8) and pre-transplant aspirin (81 mg per day) (OR 2.6, p = 0.05). A multivariate analysis further confirmed the cumulative transplant procedure number (p < 0.001) and heparin dose ≥45 U/kg (p = 0.02) as independent risk factors for bleeding. Effective mechanical sealing of the intrahepatic portal catheter tract with thrombostatic coils and tissue fibrin glue completely prevented bleeding in all subsequent procedures (n = 26, p = 0.02). We conclude that bleeding after percutaneous islet implantation is an avoidable complication provided the intraparenchymal liver tract is sealed effectively.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevention of Bleeding After Islet Transplantation: Lessons Learned from a Multivariate Analysis of 132 Cases at a Single Institution

Villiger

Ryan

Owen

et al. 2005

American Journal of Transplantation

154

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“…Transplantation was done under local anesthesia with ultrasound approach of the portal vein and through a 6 French catheter for the first 13 infusions or a 4.5 French catheter thereafter. At the end of the procedure, gelatinsponge particles (Gelfoam, Pfizer, Zurich, Switzerland) were embolized into the liver parenchymal tract and an ultrasonographic control was performed (18).…”

Section: Islet Transplantationmentioning

confidence: 99%

Sequential Kidney/Islet Transplantation: Efficacy and Safety Assessment of a Steroid-Free Immunosuppression Protocol

Toso

Baertschiger

Morel

et al. 2006

American Journal of Transplantation

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The aim of this study was to assess the efficiency and safety of the Edmonton immunosuppression protocol in recipients of islet-after-kidney (IAK) grafts. Fifteen islet infusions were administered to 8 patients with type 1 diabetes and a functioning kidney graft. Immunosuppression was switched on the day of transplantation to a regimen associating sirolimus-tacrolimus-daclizumab. Insulinindependence was achieved in all patients for at least 3 months, with an actual rate of 71% at 1 year after transplantation (5 of 7 patients). After 24-month mean follow-up, five have ongoing insulin independence, 11-34 months after transplantation, with normal HbA1c, fructosamine and mean amplitude of glycemic excursions (MAGE) values. Results of arginine-stimulation tests improved over time, mostly after the second islet infusion. Severe adverse events included bleeding after percutaneous portal access (n = 2), severe pneumonia attributed to sirolimus toxicity (n = 1), kidney graft loss after immunosuppression discontinuation (n = 1), reversible humoral kidney rejection (n = 1) and fever of unknown origin (n = 1). These data indicate that the Edmonton approach can be successfully applied to the IAK setting. This procedure is associated with significant side effects and only patients with stable function of the kidney graft should be considered. The net harm versus benefit has not yet been established and will require further studies with larger numbers of enrolled subjects.

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“…Islet isolations gated more formally using a multiple logistic regression yielding ≥ 300,000 IEQ of the recipient's body weight model for their adjusted associations with transplantabilwere considered successful and suitable for transplantaity. Stepwise model building strategy was employed on tion (11,14,15,46). the factors with bivariate evidence of association until a final model was determined from our data.…”

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confidence: 99%

Toward Maximizing the Success Rates of Human Islet Isolation: Influence of Donor and Isolation Factors

et al. 2007

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In order to make islet transplantation a therapeutic option for patients with diabetes there is an urgent need for more efficient islet cell processing to maximize islet recovery. Improved donor management, organ recovery techniques, implementation of more stringent donor criteria, and improved islet cell processing techniques may contribute to enhance organ utilization for transplantation. We have analyzed the effects of donor and islet processing factors on the success rate of human islet cell processing for transplantation performed at a single islet cell processing center. Islet isolation outcomes improved when vasopressors, and in particular pitressin, and steroids were used for the management of multiorgan donors. Higher islet yields were obtained from adult male donors, BMI >25 kg/m 2 , adequate glycemic control during hospital stay, and when the pancreas was retrieved by a local surgical team. Successful isolations were obtained in 58% of the cases when ≥ 4 donor criteria were met, and even higher success rates (69%) were observed when considering ≥ 5 criteria. Our data suggest that a sequential, integrated approach is highly desirable to improve the success rate of islet cell processing.Key words: Pancreatic islets; Islet transplantation; Organ selection; Islet isolation; Donor management; Pancreas preservation; Pancreas recovery; Islet purification INTRODUCTION deceased donor pancreata. There is an urgent need for the definition of more stringent donor selection criteria that could help maximize the success rate of human islet Transplantation of allogeneic pancreatic islets can improve metabolic control and quality of life in patients cell processing (27,33,39,41,43,46,72). The use of regional islet cell processing centers supporting clinical with unstable type 1 diabetes (T1D) (11,13,46,47,49, 59,62). Insulin independence is generally achieved by islet transplant programs (CITP) at remote sites has proven effective in this direction (14,23). transplanting ϳ12,000 islet equivalents (IEQ)/kg of recipient body weight (11,49,59,62). Sufficient islet numIn the present study, we have analyzed the effects of donor and islet processing factors on the success rate of bers can be obtained from a single donor (11,19,62,63), but generally more than one islet preparation per recipihuman islet cell processing for transplantation performed at a single islet cell processing center. ent is required to observe insulin independence after transplantation (11,14,32,59,62). Steady progress has been obtained in recent years thanks to improved organ MATERIALS AND METHODS recovery and preservation methods (9,26,28,50), and isPancreas Procurement let isolation and purification techniques (1,22,29,52). The high islet numbers required to achieve insulin indePancreata were obtained from multiorgan, deceased donors ( (2,11,12,14). Additional organs were most of the critical steps of cell processing (namely, duct cannulation, pancreas trimming, and decision on obtained through the Texas Organ Sharing Network under an ongoing part...

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Pancreatic Islet Transplantation

Abstract: We believe that PIT should be performed by a small number of experienced interventional radiologists using ultrasound guidance and posttransplant embolization of the hepatic parenchymal tract.

Cited by 74 publications

References 28 publications

Prevention of Bleeding After Islet Transplantation: Lessons Learned from a Multivariate Analysis of 132 Cases at a Single Institution

Prevention of Bleeding After Islet Transplantation: Lessons Learned from a Multivariate Analysis of 132 Cases at a Single Institution

Sequential Kidney/Islet Transplantation: Efficacy and Safety Assessment of a Steroid-Free Immunosuppression Protocol

Toward Maximizing the Success Rates of Human Islet Isolation: Influence of Donor and Isolation Factors

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