A comparison of islet autotransplantation with allotransplantation and factors elevating acute portal pressure in clinical islet transplantation

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 19; no. 3; pp. 281 - 288
• Main Authors: Kawahara, Toshiyasu, Kin, Tatsuya, Shapiro, A.M. James
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01.05.2012; Springer Japan; Wiley Subscription Services, Inc
• Subjects: Abdominal Surgery; clinical islet transplantation; Diabetes Mellitus, Type 1 - surgery; Follow-Up Studies; Gastroenterology; Hepatology; Humans; Hypertension, Portal - etiology; Hypertension, Portal - physiopathology; Injections, Intravenous; Islets of Langerhans Transplantation - adverse effects; Islets of Langerhans Transplantation - methods; Liver cirrhosis; Medicine; Medicine & Public Health; Original Article; Portal Pressure; Portal Vein; portal vein thrombosis; portal venous pressure; Portography; Postoperative Complications; Retrospective Studies; Risk Factors; Surgical Oncology; Transplantation, Autologous; Transplantation, Homologous; Transplants & implants; Venous Thrombosis - complications; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - physiopathology; Portal venous pressure; Clinical islet transplantation; Portal vein thrombosis
• ISSN: 1868-6974; 1868-6982; 1868-6982
• DOI: 10.1007/s00534-011-0441-2

Background Acute portal pressure rise is occasionally observed during intraportal islet infusion, especially in islet autotransplantation (IAT) where tissue purification is rarely applied. In this paper we investigate factors associated with acute portal pressure rise, a known risk factor for portal vein thrombosis. Methods Retrospective data was collected on 15 islet autotransplant and 122 allogeneic islet transplant subjects. Non-purified pancreatic cells were transplanted in islet autotransplants, and purified islet cells were transplanted in allogeneic transplants. Portal pressure was documented throughout the islet infusion. Results The total numbers of transplanted islets were significantly smaller in autotransplants than allografts, although the packed cell volume in autotransplants was larger. Autoislet infusion, with a larger packed cell volume, caused higher transient portal venous pressures than allogeneic islet transplant. Univariate analysis and multivariate linear regression revealed that packed cell volume and the number of transplanted cells were significant risk factors for acute portal pressure rise in both autotransplants and allogeneic transplants. Conclusions Non-purified IAT has a higher risk for acute portal pressure rise than allogeneic islet transplantation, and the rise is associated with the packed cell volume and the number of transplanted cells. Minimization of packed cell volume and cautious monitoring of portal pressure are important to avoid potential complications of portal hypertension.