Abstract
P447 Aims: To evaluate the safety and feasibility of percutaneous transhepatic beta cell transplantation in patients with type 1 diabetes mellitus using a combined ultrasound- and fluoroscopy-guided puncture technique. Methods: Between December 2001 and November 2003, 15 C-peptide negative type 1 diabetic patients underwent 31 percutaneous beta cell transplantation procedures in our JDRF center. In 13 cases the transplant procedure was done under sedation, while in 18 cases general anesthesia was given, in 12 cases using a laryngeal mask and in 6 an endotracheal tube. In all procedures percutaneous access to the right portal vein was made under ultrasound guidance and subsequent catherisation of the main portal vein was performed under fluoroscopic control. The volume of beta cell grafts injected for each procedure was recorded as well as the total procedure time. Clinical, biochemical and radiological evaluation was performed before and after the procedure. Results: In all cases it was possible to achieve access to the portal vein (median number of seeker needle passes = 1, range 1 – 6). The volume of cultured beta cell grafts injected for each transplantation was 0.58 ml (range 0.26 – 1.60 ml) and the recorded procedure time (from puncture to catheter withdrawal) was 19 min (range 10 – 80 min). Three patients presented with transient abdominal pain immediately after the procedure; postprocedural duplex ultrasound of the liver revealed a patent portal vein and endbranches in all cases and a minor perihepatic fluid collection in 3 patients. From the end of week 1 up to week 3, an increase in liver transaminases was measured in all recipients (3.0 fold, range 1.8 – 11.3 fold). Conclusions: The combined ultrasound and fluoroscopic monitoring of percutaneous transhepatic injection is a new, safe and reproducible radiological procedure for transplantation of beta cell grafts in type 1 diabetic patients.
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