Insulin independence achieved using the transmesenteric approach to the portal vein for islet transplantation

A. Osama Gaber, Abbas Chamsuddin, Daniel Fraga, Jonathan Fisher, Agnes Lo

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Clinical human islet transplantation has been performed successfully using a percutaneous transhepatic approach to access the portal vein. The risks from percutaneous delivery of islets, such as bleeding and puncturing neighboring structures, can be avoided by a transmesenteric approach to the portal vein, which we have used to stent completely or near-completely occluded portal veins in both cirrhotic and noncirrhotic patients with minimum morbidity. After minilaparotomy, a second-order tributary branch of the mesenteric vein is cannulated to provide endovascular access to the portal vein. The islet preparation is infused through a catheter directed under fluoroscopy from the mesenteric vein to the portal vein. Pre- and postinfusion portograms are obtained to confirm the absence of any interval changes in portal venous flow. We have performed this procedure successfully in three islet-transplant recipients each receiving two infusions on separate occasions, with some of these procedures performed under local anesthesia without complications. The transmesenteric approach promises to be a safe alternative to percutaneous islet delivery.

Original languageEnglish (US)
Pages (from-to)309-311
Number of pages3
JournalTransplantation
Volume77
Issue number2
DOIs
StatePublished - Jan 27 2004

ASJC Scopus subject areas

  • Transplantation

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