Document Detail


Technique, complications, and therapeutic efficacy of percutaneous transplantation of human pancreatic islet cells in type 1 diabetes: the role of US.
MedLine Citation:
PMID:  15591436     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To retrospectively evaluate the role of ultrasonography (US) with regard to the technique, complications, and therapeutic efficacy of percutaneous intrahepatic transplantation of human pancreatic islet cells with combined US and fluoroscopic guidance. MATERIALS AND METHODS: The institutional review board approved the study, and informed consent was obtained from all patients. After kidney transplantation, 34 uremic diabetic patients (20 men, 14 women; mean age, 40.9 years; age range, 29-61 years) underwent percutaneous intrahepatic transplantation of islet cells. Portal vein patency and liver echotexture were preliminarily assessed with color Doppler US. US also was used to identify early complications and presence (group A patients) or absence (group B patients) of hepatic parenchymal changes. Differences between the two groups in C peptide serum level and range were analyzed (Mann-Whitney test). Therapeutic efficacy of transplantation was assessed with regard to insulin independence period (rate and duration), exogenous insulin requirement, glycated hemoglobin, and C peptide level. A C peptide level of more than 0.5 ng/mL was considered to indicate well-functioning islet cells. RESULTS: Fifty-eight procedures were technically successful, with a single puncture used in 51 of 58 patients. Complications occurred in three of 58 patients (hemoperitoneum, hemothorax, and thrombosis in one patient each) and were conservatively treated and resolved. Duration of insulin independence in 12 patients was more than 3 months (mean, 21 months). Well-functioning islet cells at 6 years were found in 19 of 34 patients. Hyperechoic parenchymal changes were evident at US in 12 of 34. No statistically significant difference in C peptide level was found between groups (P > .05), but a wider range of values was recorded in group B. CONCLUSION: Complication rate of transplantation with US and fluoroscopic guidance was low. Well-functioning islet cells were found in about 50% of patients at 6 years of follow-up. Hepatic implantation of islet cells was evident on US images in more than one-third of patients.
Authors:
Massimo Venturini; Enzo Angeli; Paola Maffi; Paolo Fiorina; Federico Bertuzzi; Marco Salvioni; Francesco De Cobelli; Carlo Socci; Luca Aldrighetti; Claudio Losio; Valerio Di Carlo; Antonio Secchi; Alessandro Del Maschio
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2004-12-10
Journal Detail:
Title:  Radiology     Volume:  234     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-26     Completed Date:  2005-03-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  617-24     Citation Subset:  AIM; IM    
Copyright Information:
(c) RSNA, 2004.
Affiliation:
Department of Radiology, San Raffaele Scientific Institute, Vita-Salute University, Olgettina 60, 20132 Milan, Italy. venturini.massimo@hsr.it
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MeSH Terms
Descriptor/Qualifier:
Adult
C-Peptide / blood
Diabetes Mellitus, Type 1 / surgery*
Female
Fluoroscopy
Hemoglobins, Abnormal / analysis
Humans
Immunosuppression
Insulin / administration & dosage
Islets of Langerhans Transplantation / methods*
Liver / surgery,  ultrasonography*
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Treatment Outcome
Ultrasonography, Doppler, Color
Chemical
Reg. No./Substance:
0/C-Peptide; 0/Hemoglobins, Abnormal; 0/hemoglobin, glycerated; 11061-68-0/Insulin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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