Portal venous pressure changes after sequential clinical islet transplantation

Area of Science:

• Endocrinology
• Transplantation Immunology
• Vascular Surgery

Background:

• Pancreatic islet transplantation via the portal vein enables insulin independence in type 1 diabetes.
• Potential complications of portal vein islet infusion necessitate further investigation.
• This study aimed to characterize portal venous pressure changes during islet transplantation.

Purpose of the Study:

• To assess portal venous pressure dynamics following sequential islet transplantation.
• To identify factors influencing portal pressure elevation during islet infusion.
• To evaluate the safety and efficacy of the portal vein route for islet transplantation.

Main Methods:

• Collected pre- and posttransplant portal venous pressures in 26 patients undergoing 50 islet transplant procedures.
• Utilized radiologically placed portal venous cannulas for islet infusion.
• Performed Doppler ultrasound scans of the portal vein within 24 hours post-transplantation.

Main Results:

• Portal venous pressure significantly increased post-transplantation, particularly with sequential procedures (12.4 mm Hg vs. 17.3 mm Hg).
• Elevated portal pressure correlated significantly with islet packed cell volume and the total number of islets transplanted.
• Portal vein thrombosis occurred in 4% of procedures.

Conclusions:

• Multiple sequential islet transplants can be safely administered via the portal vein.
• Meticulous islet purification and vigilant portal venous pressure monitoring are essential for safe islet transplantation.
• This approach offers a viable strategy for achieving insulin independence in type 1 diabetes.