Pancreatic islet transplantation: the radiographic approach

Successful pancreatic islet transplantation (PIT) has resulted in several transplant centers wanting to start PIT programs. PIT remains experimental and must be performed safely for its continued use. We describe the radiographic techniques used at our center and their results.

Between January 17, 2002, and December 16, 2002, 17 percutaneous transhepatic PITs were performed by two interventional radiologists. Ultrasound localization of and guidance to the portal vein (PV) were used. Portosplenography confirmed the position of the PV islet infusion catheter, and PV pressure was documented before, during, and at the completion of PIT. To prevent PV thrombosis, heparin (17.5 U/kg) through the PV infusion catheter and subcutaneous enoxaparin (Lovenox, Aventis Pharmaceuticals, Parsippany, NJ) were administered after PIT. At the completion of PIT, thrombin-saturated Gelfoam (Johnson and Johnson, Summerville, NJ) was embolized into the hepatic parenchymal tract.

Percutaneous PV access was achieved in all cases (median number of seeker needle passes=2, range: 1-6), and PIT was performed. In no case was any extrahepatic organ punctured, and sustained PV hypertension was not seen. No patient required transfusion, and it was documented by Doppler ultrasonography that PV thrombosis did not result from PIT. In addition, intraparenchymal and intraabdominal bleeding did not complicate any PIT; 71% and 59% of the patients experienced moderate posttransplant abdominal pain and nausea, respectively. All patients demonstrated a self-limited, asymptomatic posttransplant transaminitis.

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.