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Technique, Complications, and Therapeutic Efficacy of Percutaneous Transplantation of Human Pancreatic Islet Cells in Type 1 Diabetes: The Role of US¹

¹ From the Department of Radiology (M.V., E.A., M.S., F.D.C., C.L., A.D.M.), Department of Internal Medicine, Transplant Unit (P.M., P.F., F.B., A.S.), and Department of General Surgery (C.S., L.A., V.D.C.), San Raffaele Scientific Institute, Vita-Salute University, Olgettina 60, 20132 Milan, Italy. From the 2002 RSNA Annual Meeting. Received August 25, 2003; revision requested November 6; final revision received March 31, 2004; accepted April 15. Supported in part by Ministero della Sanità (Ricerca Finalizzata [RF] 1999 and 2001, RF 99.52 and RF 01.184) and Ministero della Ricerca Scientifica (Cofinanziamento 2002). Address correspondence to M.V. (e-mail: venturini.massimo@hsr.it).

View larger version (101K): [in a new window]   Figure 1. Technique. Intercostal US image obtained during transplantation shows insertion of needle (single arrow) into liver, adjacent to right portal vein (double arrows): Only the lateral wall of the vein is punctured.

View larger version (158K): [in a new window]   Figure 2. Complication. Intercostal US image, obtained 24 hours after transplantation, shows a large fluid collection (arrows) around the liver, a sign of hemoperitoneum.

View larger version (149K): [in a new window]   Figure 3a. Complication. (a) Transverse color Doppler US image and (b) transverse contrast-enhanced CT image both demonstrate segmental thrombosis in a branch of the right portal vein (arrows). (c) Transverse CT image obtained 48 hours after transplantation shows peripheral hypoattenuation (arrows) due to reduced vascular perfusion, without any damage to transplanted pancreatic islet cell function.

View larger version (140K): [in a new window]   Figure 3b. Complication. (a) Transverse color Doppler US image and (b) transverse contrast-enhanced CT image both demonstrate segmental thrombosis in a branch of the right portal vein (arrows). (c) Transverse CT image obtained 48 hours after transplantation shows peripheral hypoattenuation (arrows) due to reduced vascular perfusion, without any damage to transplanted pancreatic islet cell function.

View larger version (140K): [in a new window]   Figure 3c. Complication. (a) Transverse color Doppler US image and (b) transverse contrast-enhanced CT image both demonstrate segmental thrombosis in a branch of the right portal vein (arrows). (c) Transverse CT image obtained 48 hours after transplantation shows peripheral hypoattenuation (arrows) due to reduced vascular perfusion, without any damage to transplanted pancreatic islet cell function.

View larger version (35K): [in a new window]   Figure 4. Therapeutic efficacy. A, Line graph shows percentage of patients with well-functioning pancreatic islet cells and C peptide level of more than 0.5 ng/mL at follow-up evaluations at months 1 (n = 34), 6 (n = 30), 12 (n = 25), 24 (n = 22), 36 (n = 19), 48 (n = 17), 60 (n = 16), 72 (n = 13), and 84 (n = 10) after transplantation. B-D, Bar graphs show, respectively, mean percentage of glycated hemoglobin, mean C peptide level, and mean exogenous insulin requirement at each follow-up interval.

View larger version (131K): [in a new window]   Figure 5a. Therapeutic efficacy. (a) Transverse US image of the right hepatic lobe at the level of the right hepatic vein, obtained before pancreatic islet cell transplantation, shows homogeneous echotexture. (b) Transverse US image obtained at the same level 9 months after transplantation shows inhomogeneous echotexture, with a hyperechoic focal area (arrows) probably due to local insulin production, a sign of islet cell vitality.

View larger version (135K): [in a new window]   Figure 5b. Therapeutic efficacy. (a) Transverse US image of the right hepatic lobe at the level of the right hepatic vein, obtained before pancreatic islet cell transplantation, shows homogeneous echotexture. (b) Transverse US image obtained at the same level 9 months after transplantation shows inhomogeneous echotexture, with a hyperechoic focal area (arrows) probably due to local insulin production, a sign of islet cell vitality.

View larger version (15K): [in a new window]   Figure 6. Box plots show therapeutic efficacy compared in two patient groups. Different distribution of C peptide levels is evident at 6 months after pancreatic islet cell transplantation in group A (patients with hepatic parenchymal changes) and group B (patients without hepatic parenchymal changes), with a wider range of C peptide values in group B than in group A. Hepatic parenchymal changes were evident in patients with partial pancreatic islet cell function but not in those with full function or without function of transplanted islet cells: This feature could be related to high insulin concentration due to a few hyperfunctioning islet cells. Shaded boxes indicate ranges of measured values between the 25th and 75th percentiles, horizontal lines inside boxes indicate medians, and whiskers indicate values of the 5th and 95th percentiles.