Patients with Type I diabetes require lifelong exogenous Insulin. Islet cell transplantation has the potential to cure this condition through percutaneous intrahepatic islet cell transplantation. We analyzed our experience with this technique, including ultrasound guided access of the appropriate vein and catheter infusion of the islet cells. A special focus on the unique closure of the tract with our coil and gelfoam sandwich technique is included.
METHOD AND MATERIALS
Between 1/1/2002 and 3/7/2005, in 13 patients with poorly controlled type I diabetes, 15 percutaneous islet cell transplants were completed. Under ultrasound guidance, a portal vein was accessed and the islet cells were infused with portal vein pressure monitoring. The tract was closed with the sandwich method. The number of attempts required for portal vein access as well as complications during and after the procedure were evaluated. Hemoglobin, liver function tests (AST, ALT), and WBC counts during the first 30 days were monitored.
Using ultrasound guidance, the right portal vein was accessed in 80% of cases; the left in 20%. The portal vein was successfully accessed with the first attempt in 66.7% of cases; the 2nd attempt in 26.7%. In one case, multiple attempts were needed because of poor technique by the radiologist in tracking the tip of the needle by ultrasound. There was no portal vein thrombosis, hematoma, hemorrhage from the tract, or septicemia during the first 30 days after transplantation. Anemia ranged from 1/5 to 3/5 in 86.7% of cases, with 2 cases demonstrating no anemia. Abnormal liver function tests ranged from 1/5 to 4/5 in 100% of cases. There were no deaths.
Our technique of intrahepatic islet cell transplantation using ultrasound guidance and closure with the sandwich technique was successful without post-procedure hemorrhage, hematoma, portal vein thrombosis, or septicemia during the first 30 days. In our sandwich technique, the coils slowed flow in the tract and the gelfoam occluded the tract. This combination is ideal for preventing complications, making islet cell transplantation a safe, minimally invasive procedure.