Percutaneous approach for human islet transplantation.

Two male patients. aged 29 and 36 years. received combined cadaveric kidney-islet grafts for end-stage renal disease secondary to type I diabetes mellitus. The kidneys and pancreas were obtained from multiorgan donor procurement.2 The organs were preserved in UW solution and packed on ice. The pancreas ofthe kidney donor was the source of the primary islet allograft in the 29-year-old patient. A second islet preparation was infused 2 days later by the percutaneous approach. The 36-year·old recipient received a kidney allograft and islets from a different donor 8 days after the kidney transplant. The human islet preparation were obtained by a modificationJ of the automated method4 for human islet isolation. After documentation of patency of the portal vein by Doppler ultrasonography the right midaxillary line and the tenth or eleventh rib interspace were used as landmarks to locate peripheral portal vein branches. After prepping the skin in this area with betadine solution, the interspace was palpated and anesthetized with 2% lidocaine. A short skin incision was made and a 22-gauge Chiba needle was introduced into the liver via the incision in the midaxillary line. The needle was passed through the parenchyma in the coronal plane to the edge of the spine. A portal vein branch was isolated by injecting radiopaque contrast (iopamidole 3(0) through the Chiba needle while slowly withdrawing the needle. The position of the needle and the contrast injection were observed ftuoroscopicaliy. A portal vein branch was identified by observing the pattern of distribution of contrast.5-7 When the branch was identified. a O.18-in steel guide was introduced through the needle lumen. A 4F or 5F catheter was passed over the guide wire through the liver parenchyma into the lumen of the portal vein. Radiopaque contrast was injected through the catheter and an angiogram was obtained to outline the anatomy of the intraand extrahepatic portal vein (Fig 1). The pancreatic islet cells were then slowly infused by gravity through the catheter into the main portal vein.The islet infusion lasted 10 to 20 minutes. There were no complications. When the infusion was completed. the catheter was withdrawn and the patient was kept at bed rest for 3 hours with periodic monitoring of the vital signs and hematocrit.