Islet Cell Transplantation

Airway: Own
Access: CVC may be required for blood sampling
Pain: Minimal
Position: Supine
Time: ~1 hour
Blood loss: Post-opereative haemorrhage or hepatic bleeding may occur
Special: BSL monitoring may be required

Transplantation of donor islet cells into a pancreas to achieve independence from insulin, as an alternative to whole pancreas transplantation. Patients undergoing islet cell transplants usually are:

• Type-1 diabetics
• Poor recognisers of hypoglycaemia
• Experiencing recurrent, severe hypoglyaemic epidosies
• Otherwise optimally managed
• Rare
  Most patients can be managed without requring transplantation.

Considerations

• D
  • DM
    
    • Indications
      Requires all of:
      • Insulin sensitive
      • C-peptide negative
      • Documented severe unnoticed hypoglycaemic episodes
      • Without renal impairment
    • Complications
• E
  • Co-existing endocrine disease

Preparation

Induction

• Sedation for interventional radiology

Intraoperative

Surgical stages:

• Percutaneous cannulation of the portal vein
  Often large (e.g. 4 Fr).
• Measurement of portal venous pressure
• Infusion of purified islets in transplant medium into portal vein
• Removal of catheter

Postoperative

Further management includes:

• Immunosuppression
  • Steroids
  • Calcineurin inhibitors
    May require conversion to MMF.

Surgical complications include:

• Bleeding
• Portal vein thrombosis
• Portal hypertension

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References

1. Srinivasan P, Huang GC, Amiel SA, Heaton ND. Islet cell transplantation. Postgrad Med J. 2007;83(978):224-9.