P-175

Portal venography and portal venous pressure assessment for one week following total pancreatectomy and islet auto-transplantation using a recannulated umbilical vein catheter

C. Pollard, W.Y. Chung, A. Arshad, G. Gravante, S.L. Ong, S. Illouz, M.A. Webb, A.R. Dennison
University Hospitals of Leiceter NHS Trust, Leicester, U.K.

Objectives: Pancreatic islet transplantation is an effective treatment for uncontrolled, symptomatic type I diabetes. Percutaneous transhepatic portal vein cannulation is a well established method of islet allo-transplantation, but may result in high rates of portal vein thrombosis and recipient complications. Islet cell autotransplantation, particularly when performed in patients undergoing total pancreatectomy for chronic pancreatitis may be achieved by infusion through a catheter placed in the umbilical vein remnant in the falciform ligament thus providing direct access into the portal system. We describe a novel method of assessing potential local portal vein thrombotic complications in pancreatic islet cell autotransplantation up to one week after islet infusion.

Methods: Two patients undergoing total pancreatectomy for chronic pancreatitis with subsequent auto-transplantation of islet cells had umbilical vein catheters placed for postoperative portal venous assessment. These catheters were manipulated by a single operating surgeon into the main portal vein. Venograms were performed by injection of contrast into the catheters at day 3 and 6 following islet infusion to assess portal vein patency. Portal vein pressure assessment was carried out hourly for the first 24 hours and four hourly thereafter

Results: There was no difference in venogram appearances in the patients between days 3 and 6 post infusion with no evidence of portal vein thrombosis. Portal vein pressures showed a mean increase of 10mm hg at day 3 and 6 over the pre-infusion baseline and were stable between the end of the infusion and removal of the catheter.

Conclusions: Umbilical vein cannulation, venogram and portal vein pressure assessment for the demonstration of patency up to 7 days post islet cell auto-transplant is safe, technically straightforward and not associated with increased risk of complications. The post infusion venogram and portal vein pressure assessment demonstrate the safety of islet infusion using this approach.

P-175

Portal venography and portal venous pressure assessment for one week following total pancreatectomy and islet auto-transplantation using a recannulated umbilical vein catheter

C. Pollard, W.Y. Chung, A. Arshad, G. Gravante, S.L. Ong, S. Illouz, M.A. Webb, A.R. Dennison
University Hospitals of Leiceter NHS Trust, Leicester, U.K.

Objectives: Pancreatic islet transplantation is an effective treatment for uncontrolled, symptomatic type I diabetes. Percutaneous transhepatic portal vein cannulation is a well established method of islet allo-transplantation, but may result in high rates of portal vein thrombosis and recipient complications. Islet cell autotransplantation, particularly when performed in patients undergoing total pancreatectomy for chronic pancreatitis may be achieved by infusion through a catheter placed in the umbilical vein remnant in the falciform ligament thus providing direct access into the portal system. We describe a novel method of assessing potential local portal vein thrombotic complications in pancreatic islet cell autotransplantation up to one week after islet infusion.

Methods: Two patients undergoing total pancreatectomy for chronic pancreatitis with subsequent auto-transplantation of islet cells had umbilical vein catheters placed for postoperative portal venous assessment. These catheters were manipulated by a single operating surgeon into the main portal vein. Venograms were performed by injection of contrast into the catheters at day 3 and 6 following islet infusion to assess portal vein patency. Portal vein pressure assessment was carried out hourly for the first 24 hours and four hourly thereafter

Results: There was no difference in venogram appearances in the patients between days 3 and 6 post infusion with no evidence of portal vein thrombosis. Portal vein pressures showed a mean increase of 10mm hg at day 3 and 6 over the pre-infusion baseline and were stable between the end of the infusion and removal of the catheter.

Conclusions: Umbilical vein cannulation, venogram and portal vein pressure assessment for the demonstration of patency up to 7 days post islet cell auto-transplant is safe, technically straightforward and not associated with increased risk of complications. The post infusion venogram and portal vein pressure assessment demonstrate the safety of islet infusion using this approach.