The First Case of Intraportal Islet Implantation during Liver Machine Perfusion Allowing Simultaneous Islet-liver Transplantation in a Human - A New and Safe Treatment for End-stage Liver Disease Combined with Diabetes Mellitus

Objective: Evaluating the safety and efficacy of implanting a liver with islet grafts into patients with end-stage liver disease and diabetes mellitus (DM). Background: DM and end-stage liver diseases are significant health concerns worldwide, often coexisting and mutually influencing each other. Addressing both diseases simultaneously is paramount. Methods: We utilized the islet transplantation combined ischemia-free liver transplantation technique to treat a patient with hepatocellular carcinoma and type 2 diabetes mellitus. The liver was procured and preserved using the ischemia-free liver transplantation technique, and during normothermic machine perfusion, isolated and purified islet grafts were transplanted into the liver through the portal vein. Finally, the liver, incorporating with the transplant islet grafts, was implanted into the recipient without interruption of blood supply. Results: The patient received both liver and islet grafts from the same donor. The patient achieved insulin-independence by post-transplant day 9, and both liver and islet function remained robust. The patient was discharged on post-transplant day 16 and experienced no surgical or transplantation-related complications during the follow-up period. Furthermore, islet grafts presence was observed in liver biopsies after islet transplantation. Conclusions: This landmark case marks the inaugural application of ischemia-free liver transplantation in humans, signifying its potential as a promising treatment modality for end-stage liver disease with DM.