BACKGROUND: In type 1 diabetics undergoing allogenic islet transplants, transaminitis and portal vein thrombosis (PVT) after transhepatic portal infusion of islets may be related to infusion pressure and the purity of islets. Complications of intraoperative portal infusion of islets in patients with chronic pancreatitis undergoing a total pancreatectomy (TP) and autologous islet transplant (AIT) and the relationship to liver histopathology have not been examined. AIM: The purpose of this study was to examine complications of intraportal infusion of autologous islets after TP. METHODS: Data on 26 TP-AIT patients were analyzed. RESULTS: Infusion of islets [mean 304,473 ± 314,557 islet equivalents, median volume 300 mL (50-600)] resulted in mean postinfusion PV pressure of 9.15 ± 10.09 cmH2O which correlated with infused islets equivalents (r (2) = 33.6, P = 0.002) and volume (r (2) = 30.4, P = 0.005). Of 23 patients undergoing liver biopsy, 8 (35 %) were normal, 10 (43 %) had steatosis, and 5 (22 %) periportal fibrosis. Peak alanine aminotransferase (ALT; median 1 day after infusion) differed among the three histologic groups (P = 0.025). The difference in ALT was statistically significant between steatosis (showed the greatest increase) and the other two groups, but not between the normal and fibrosis groups. No correlation was found between the portal pressure increase at infusion and other variables. Two patients that developed PVT on day 1 had the highest infusion pressures; a third occurred on day 5. CONCLUSION: Preexisting liver pathology is a contributing factor in the rise in liver enzymes but does not correlate with development of PV thrombosis.
BACKGROUND: In type 1 diabetics undergoing allogenic islet transplants, transaminitis and portal vein thrombosis (PVT) after transhepatic portal infusion of islets may be related to infusion pressure and the purity of islets. Complications of intraoperative portal infusion of islets in patients with chronic pancreatitis undergoing a total pancreatectomy (TP) and autologous islet transplant (AIT) and the relationship to liver histopathology have not been examined. AIM: The purpose of this study was to examine complications of intraportal infusion of autologous islets after TP. METHODS: Data on 26 TP-AIT patients were analyzed. RESULTS: Infusion of islets [mean 304,473 ± 314,557 islet equivalents, median volume 300 mL (50-600)] resulted in mean postinfusion PV pressure of 9.15 ± 10.09 cmH2O which correlated with infused islets equivalents (r (2) = 33.6, P = 0.002) and volume (r (2) = 30.4, P = 0.005). Of 23 patients undergoing liver biopsy, 8 (35 %) were normal, 10 (43 %) had steatosis, and 5 (22 %) periportal fibrosis. Peak alanine aminotransferase (ALT; median 1 day after infusion) differed among the three histologic groups (P = 0.025). The difference in ALT was statistically significant between steatosis (showed the greatest increase) and the other two groups, but not between the normal and fibrosis groups. No correlation was found between the portal pressure increase at infusion and other variables. Two patients that developed PVT on day 1 had the highest infusion pressures; a third occurred on day 5. CONCLUSION: Preexisting liver pathology is a contributing factor in the rise in liver enzymes but does not correlate with development of PV thrombosis.
Authors: Syed A Ahmad; Andrew M Lowy; Curtis J Wray; David D'Alessio; Kywran A Choe; Laura E James; Andreas Gelrud; Jeffrey B Matthews; Horacio L R Rilo Journal: J Am Coll Surg Date: 2005-09-23 Impact factor: 6.113
Authors: D C Wahoff; B E Papalois; J S Najarian; D M Kendall; A C Farney; J P Leone; J Jessurun; D L Dunn; R P Robertson; D E Sutherland Journal: Ann Surg Date: 1995-10 Impact factor: 12.969
Authors: Ehab Rafael; Edmond A Ryan; Breay W Paty; Jose Oberholzer; Sharleen Imes; Peter Senior; Charlotte McDonald; Jonathan R T Lakey; A M James Shapiro Journal: Transplantation Date: 2003-11-15 Impact factor: 4.939
Authors: J S Najarian; D E Sutherland; D Baumgartner; B Burke; J J Rynasiewicz; A J Matas; F C Goetz Journal: Ann Surg Date: 1980 Impact factor: 12.969