Portal venous pressure changes after sequential clinical islet transplantation

Casey, John; Lakey, Jonathan R. T.; Ryan, Edmond A.; Paty, Breay W.; Owen, Richard; O’Kelly, Kevin; Nanji, Sulaiman; Rajotte, Ray V.; Korbutt, Gregory S.; Bigam, David L.; Kneteman, N.; Shapiro, A.M. James

doi:10.1097/00007890-200210150-00002

Cited by 135 publications

(75 citation statements)

References 8 publications

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“…The rationale behind these alternative sites was the avoidance of portal hypertension, venous thrombosis and infarction. When the liver was used as the site of islet transplantation, intraportal pressure monitoring during infusion of islets was recommended to avoid portal hypertension and its complications 16 .…”

Section: Islet Isolation and Infusionmentioning

confidence: 99%

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Bramis

Gordon-Weeks

Friend

et al. 2012

British Journal of Surgery

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Background: Total pancreatectomy and islet autotransplantation (TP/IAT) is a treatment option in a subset of patients with chronic pancreatitis. A systematic review of the literature was performed to evaluate the outcome of this procedure, with an attempt to ascertain when it is indicated. The impact on quality of life was poorly reported. The studies reviewed did not provide evidence for optimal timing of TP/IAT in relation to the evolution of chronic pancreatitis. Conclusion:This systematic review showed that TP/IAT had favourable outcomes with regard to pain reduction. Concurrent IAT enabled a significant proportion of patients to remain independent of insulin supplementation.

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Section: Islet Isolation and Infusionmentioning

confidence: 99%

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Bramis

Gordon-Weeks

Friend

et al. 2012

British Journal of Surgery

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“…Most recipients require two or more islet transplant procedures (combined mass of Ͼ10,000 islet equivalents [IEQs]/kg body wt) in order to become insulin independent, which is a serious drawback given the prevalence of diabetes and the limited cadaveric organ donor pool (2,3). Also, the risks associated with islet transplantation appear to increase with the number of infusions and with the total packed cell volume of cumulative grafts (4).…”

mentioning

confidence: 99%

XIAP Overexpression in Human Islets Prevents Early Posttransplant Apoptosis and Reduces the Islet Mass Needed to Treat Diabetes

et al. 2005

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The Edmonton Protocol for treatment of type 1 diabetes requires islets from two or more donors to achieve euglycemia in a single recipient, primarily because soon after portal infusion, the majority of the transplanted cells undergo apoptosis due to hypoxia and hypoxia reperfusion injury. X-linked inhibitor of apoptosis protein (XIAP) is a potent endogenous inhibitor of apoptosis that is capable of blocking the activation of multiple downstream caspases, and XIAP overexpression has previously been shown to enhance engraftment of a murine ␤-cell line. In this study, human islets transduced with a XIAP-expressing recombinant adenovirus were resistant to apoptosis and functionally recovered following in vitro stresses of hypoxia and hypoxia with reoxygenation (models reperfusion injury). Furthermore Ad-XIAP transduction dramatically reduced the number of human islets required to reverse hyperglycemia in chemically diabetic immunodeficient mice. These results suggest that by transiently overexpressing XIAP in the immediate posttransplant period, human islets from a single donor might be used to effectively treat two diabetic recipients. Diabetes 54: [2541][2542][2543][2544][2545][2546][2547][2548] 2005 T he recent introduction of the Edmonton Protocol has demonstrated that islet transplantation is a viable route to achieve insulin independence in a population of patients with type 1 diabetes (1). Despite its promise, islet transplantation remains restricted to patients with severe hypoglycemia or glycemic lability and is currently unsuitable for the majority of patients with type 1 diabetes for several reasons. Most recipients require two or more islet transplant procedures (combined mass of Ͼ10,000 islet equivalents [IEQs]/kg body wt) in order to become insulin independent, which is a serious drawback given the prevalence of diabetes and the limited cadaveric organ donor pool (2,3). Also, the risks associated with islet transplantation appear to increase with the number of infusions and with the total packed cell volume of cumulative grafts (4).Expansion of clinical islet transplantation has been limited by the large requirement for donor tissue. The fact that most patients must receive Ͼ10,000 IEQs/kg to become insulin independent suggests that a large portion of the infused islets fail to engraft sufficiently. In fact, in murine models of islet transplantation, it has been determined that even under ideal circumstances, Ͼ60% of syngeneic islet graft mass is lost due to apoptosis (5). In clinical islet transplantation, it has been estimated that more than two-thirds of the implanted islets never become functional (2).This early profound loss in islet mass can be attributed to several factors. Within a healthy pancreas, islet function is maximized by the intimate proximity of the ␤-cells and circulating blood, and, as a result, ␤-cells require a microenvironment with highly oxygenated blood (pO 2 of 40 mmHg) and abundant nutrients (6). The current method of human islet isolation and purification destroys the cap...

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“…The use of fibrin tissue sealant and embolization coils in the hepatic catheter tract seems to be effective in minimizing the bleeding risk. Another complication related to the intrahepatic islet transplantation procedure is the insurgence of portal hypertension that can occur acutely during the islet infusion especially in the case of subsequent infusions (Casey et al, 2002). The portal pressure however generally normalizes after the acute phase of the procedure.…”

Section: Complications Related To Islet Transplantationmentioning

confidence: 99%

Combined Kidney-Islet Transplantation

Cavallari¹,

Neri²,

Nardo³

2011

Understanding the Complexities of Kidney Transplantation

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Portal venous pressure changes after sequential clinical islet transplantation

Abstract: Multiple sequential islet transplants can be safely performed via the portal vein, provided that care is taken with islet purification and attention is paid to portal venous monitoring.

Cited by 135 publications

References 8 publications

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

Systematic review of total pancreatectomy and islet autotransplantation for chronic pancreatitis

XIAP Overexpression in Human Islets Prevents Early Posttransplant Apoptosis and Reduces the Islet Mass Needed to Treat Diabetes

Combined Kidney-Islet Transplantation

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