Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

Abstract

Pancreas transplantation is an exciting therapy which has been used for several decades in the treatment of diabetes mellitus. It can be performed as either a whole organ or islet cell transplant. The role of interventional radiologists in the management of whole organ transplants is evolving and includes treatment of postoperative complications and graft biopsy to evaluate for rejection. An in-depth understanding of the transplant anatomy and variations is a fundamental tool in performing these interventions successfully. Islet cell transplantation entails delivery of purified donor pancreatic islet cells into the recipient portal vein. Because of their expertise in image-guided access to the portal system, interventional radiologists play a crucial role in this procedure. The purpose of this article is to review the indications, anatomy, complications, and outcomes of both whole organ and islet cell pancreas transplants, followed by a discussion of the role of interventional radiologists in each procedure.

Keywords

pancreas transplant - whole organ pancreas transplantation - islet cell pancreas transplantation

• References

• 1 Daly B, O'Kelly K, Klassen D. Interventional procedures in whole organ and islet cell pancreas transplantation. Semin Intervent Radiol 2004; 21 (04) 335-343
• 2 Gaba RC, Garcia-Roca R, Oberholzer J. Pancreatic islet cell transplantation: an update for interventional radiologists. J Vasc Interv Radiol 2012; 23 (05) 583-594 , quiz 594
• 3 Szadkowska A, Czyżewska K, Pietrzak I, Mianowska B, Jarosz-Chobot P, Myśliwiec M. [Hypoglycaemia unawareness in patients with type 1 diabetes]. Pediatr Endocrinol Diabetes Metab 2018; 2018 (03) 126-134
• 4 Schuetz C, Markmann JF. Islet cell transplant: update on current clinical trials. Curr Transplant Rep 2016; 3 (03) 254-263
• 5 Tolat PP, Foley WD, Johnson C, Hohenwalter MD, Quiroz FA. Pancreas transplant imaging: how I do it. Radiology 2015; 275 (01) 14-27
• 6 Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery 1967; 61 (06) 827-837
• 7 http://optn.transplant.hrsa.gov
• 8 Samoylova ML, Borle D, Ravindra KV. Pancreas transplantation: indications, techniques, and outcomes. Surg Clin North Am 2019; 99 (01) 87-101
• 9 Redfield RR, Scalea JR, Odorico JS. Simultaneous pancreas and kidney transplantation: current trends and future directions. Curr Opin Organ Transplant 2015; 20 (01) 94-102
• 10 Tzvetanov I, Bejarano-Pineda L, Giulianotti PC. , et al. State of the art of robotic surgery in organ transplantation. World J Surg 2013; 37 (12) 2791-2799
• 11 Vandermeer FQ, Manning MA, Frazier AA, Wong-You-Cheong JJ. Imaging of whole-organ pancreas transplants. Radiographics 2012; 32 (02) 411-435
• 12 Siskind E, Amodu L, Liu C. , et al. A comparison of portal venous versus systemic venous drainage in pancreas transplantation. HPB (Oxford) 2019; 21 (02) 195-203
• 13 Gruessner AC. 2011 update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud 2011; 8 (01) 6-16
• 14 Senaratne NV, Norris JM. Bladder vs enteric drainage following pancreatic transplantation: how best to support graft survival? A best evidence topic. Int J Surg 2015; 22: 149-152
• 15 Siskind EJ, Amodu LI, Pinto S. , et al. Bladder versus enteric drainage of exocrine secretions in pancreas transplantation: a retrospective analysis of the united network for organ sharing database. Pancreas 2018; 47 (05) 625-630
• 16 Kaplan AJ, Valente JF, First MR, Demmy AM, Munda R. Early operative intervention for urologic complications of kidney-pancreas transplantation. World J Surg 1998; 22 (08) 890-894
• 17 Farney AC, Rogers J, Stratta RJ. Pancreas graft thrombosis: causes, prevention, diagnosis, and intervention. Curr Opin Organ Transplant 2012; 17 (01) 87-92
• 18 Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant 2005; 19 (04) 433-455
• 19 Khaja MS, Matsumoto AH, Saad WE. Vascular complications of transplantation: part 2: pancreatic transplants. Cardiovasc Intervent Radiol 2014; 37 (06) 1415-1419
• 20 Han K, Ko HK, Tsauo J. , et al. Endovascular management for the treatment of pancreas transplant venous thrombosis: a single-center experience. J Vasc Interv Radiol 2016; 27 (06) 882-888
• 21 Troppmann C, Gruessner AC, Benedetti E. , et al. Vascular graft thrombosis after pancreatic transplantation: univariate and multivariate operative and nonoperative risk factor analysis. J Am Coll Surg 1996; 182 (04) 285-316
• 22 Stockland AH, Willingham DL, Paz-Fumagalli R. , et al. Pancreas transplant venous thrombosis: role of endovascular interventions for graft salvage. Cardiovasc Intervent Radiol 2009; 32 (02) 279-283
• 23 Di Cocco P, Dholakia S, Hakim NS. Salvage of pancreas transplant after successful splenic artery thrombectomy. Exp Clin Transplant 2018; 16 (06) 769-772
• 24 Montiel-Casado MC, Fernández-Burgos I, Pérez-Daga JA. , et al. Impact of blood amylase peak over vascular graft thrombosis in pancreas transplantation. Transplant Proc 2012; 44 (09) 2627-2630
• 25 Nikolaidis P, Amin RS, Hwang CM. , et al. Role of sonography in pancreatic transplantation. Radiographics 2003; 23 (04) 939-949
• 26 van der Hem LG, van der Linden CJ, Ticheler CH, Hoitsma AJ, Corstens FH. Early detection of post-transplant pancreatic graft dysfunction with technetium-99m-HMPAO scintigraphy. J Nucl Med 1994; 35 (09) 1488-1490
• 27 Hampson FA, Freeman SJ, Ertner J. , et al. Pancreatic transplantation: surgical technique, normal radiological appearances and complications. Insights Imaging 2010; 1 (5-6): 339-347
• 28 Reslan OM, Kirsch JM, Kaul H. , et al. Endovascular stenting of portal vein for graft rescue after a pancreas transplant venous graft thrombosis: a case report. Ann Vasc Surg 2017; 42: 301.e13-301.e17
• 29 Saad WE, Darwish WE, Turba UC. , et al. Endovascular management of vascular complications in pancreatic transplants. Vasc Endovascular Surg 2012; 46 (03) 262-268
• 30 Barrufet M, Burrel M, Angeles García-Criado M. , et al. Pancreas transplants venous graft thrombosis: endovascular thrombolysis for graft rescue. Cardiovasc Intervent Radiol 2014; 37 (05) 1226-1234
• 31 Young SJ, Bergren L, Dunn T. , et al. Outcomes of endovascular management of late vascular hemorrhage after pancreatic transplant. AJR Am J Roentgenol 2018; 210 (01) 201-206
• 32 Orsenigo E, Fiorina P, Dell'Antonio G. , et al. Gastrointestinal bleeding from enterically drained transplanted pancreas. Transpl Int 2005; 18 (03) 296-302
• 33 Akhtar MZ, Jones A, Sideso E, Sinha S, Vaidya A, Darby C. Management of a ruptured mycotic pseudo-aneurysm following pancreas-kidney transplantation. Ann Transplant 2011; 16 (04) 122-125
• 34 Tan M, Di Carlo A, Stein LA, Cantarovich M, Tchervenkov JI, Metrakos P. Pseudoaneurysm of the superior mesenteric artery after pancreas transplantation treated by endovascular stenting. Transplantation 2001; 72 (02) 336-338
• 35 Semiz-Oysu A, Cwikiel W. Endovascular management of acute enteric bleeding from pancreas transplant. Cardiovasc Intervent Radiol 2007; 30 (02) 313-316
• 36 Abdel-Aal AK, Elsayed A, Saddekni S, Hamed MF, Young C. Endovascular treatment of pancreatic allograft transplant arteriovenous fistula using amplatzer vascular plug 2. Cardiovasc Intervent Radiol 2014; 37 (03) 819-824
• 37 Buttarelli L, Capocasale E, Marcato C, Mazzoni MP, Iaria M, Rossi C. Embolization of pancreatic allograft arteriovenous fistula with the Amplatzer vascular plug 4: case report and literature analysis. Transplant Proc 2011; 43 (10) 4044-4047
• 38 Arantes RM, Pantanali CA, Santos VR, Carneiro D'Albuquerque LA. Arterial pseudoaneurysm associated with pancreas and kidney transplantation: a case report. Am J Case Rep 2017; 18: 198-202
• 39 Badosa F, Mital D, Sands L. , et al. Our experience with Roux-Y intestinal drainage in simultaneous kidney and pancreas transplantation. Transpl Int 1994; 7 (Suppl. 01) S412-S413
• 40 Jiménez-Romero C, Manrique A, Morales JM. , et al. Conversion from bladder to enteric drainage for complications after pancreas transplantation. Transplant Proc 2009; 41 (06) 2469-2471
• 41 Ploeg RJ, Eckhoff DE, D'Alessandro AM. , et al. Urological complications and enteric conversion after pancreas transplantation with bladder drainage. Transplant Proc 1994; 26 (02) 458-459
• 42 Atwell TD, Gorman B, Larson TS, Charboneau JW, Ingalls Hanson BM, Stegall MD. Pancreas transplants: experience with 232 percutaneous US-guided biopsy procedures in 88 patients. Radiology 2004; 231 (03) 845-849
• 43 Uva PD, Odorico JS, Giunippero A. , et al. Laparoscopic biopsies in pancreas transplantation. Am J Transplant 2017; 17 (08) 2173-2177
• 44 Redfield RR, Rickels MR, Naji A, Odorico JS. Pancreas transplantation in the modern era. Gastroenterol Clin North Am 2016; 45 (01) 145-166
• 45 Klassen DK, Weir MR, Cangro CB, Bartlett ST, Papadimitriou JC, Drachenberg CB. Pancreas allograft biopsy: safety of percutaneous biopsy-results of a large experience. Transplantation 2002; 73 (04) 553-555
• 46 Brendel MD. , et al. International Islet Transplant Registry, Newsletter. Giessen, Germany: Justus-Liebig-University of Giessen; 2001
• 47 Shapiro AM, Lakey JR, Ryan EA. , et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000; 343 (04) 230-238
• 48 Hatziavramidis DT, Karatzas TM, Chrousos GP. Pancreatic islet cell transplantation: an update. Ann Biomed Eng 2013; 41 (03) 469-476
• 49 Fiorina P, Venturini M, Folli F. , et al. Natural history of kidney graft survival, hypertrophy, and vascular function in end-stage renal disease type 1 diabetic kidney-transplanted patients: beneficial impact of pancreas and successful islet cotransplantation. Diabetes Care 2005; 28 (06) 1303-1310
• 50 Srinivasan P, Huang GC, Amiel SA, Heaton ND. Islet cell transplantation. Postgrad Med J 2007; 83 (978) 224-229
• 51 Ryan EA, Shandro T, Green K. , et al. Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation. Diabetes 2004; 53 (04) 955-962
• 52 Cahill D, Zamboni F, Collins MN. Radiological advances in pancreatic islet transplantation. Acad Radiol 2019 (e-pub ahead of print). doi:10.1016/j.acra.2019.01.006
• 53 Matsumoto S, Noguchi H, Naziruddin B. , et al. Improvement of pancreatic islet cell isolation for transplantation. Proc Bayl Univ Med Cent 2007; 20 (04) 357-362
• 54 Agarwal A, Brayman KL. Update on islet cell transplantation for type 1 diabetes. Semin Intervent Radiol 2012; 29 (02) 90-98
• 55 Neeman Z, Hirshberg B, Harlan D, Wood BJ. Radiologic aspects of islet cell transplantation. Curr Diab Rep 2006; 6 (04) 310-315
• 56 Dixon S, Tapping CR, Walker JN. , et al. The role of interventional radiology and imaging in pancreatic islet cell transplantation. Clin Radiol 2012; 67 (09) 923-931
• 57 Kawahara T, Kin T, Kashkoush S. , et al. Portal vein thrombosis is a potentially preventable complication in clinical islet transplantation. Am J Transplant 2011; 11 (12) 2700-2707
• 58 Matsumoto I, Sawada T, Nakano M. , et al. Improvement in islet yield from obese donors for human islet transplants. Transplantation 2004; 78 (06) 880-885
• 59 Low G, Hussein N, Owen RJ. , et al. Role of imaging in clinical islet transplantation. Radiographics 2010; 30 (02) 353-366
• 60 Gaba RC, Kobayashi KR, Bui JT. , et al. Liver track embolization after islet cell transplant: comparison of two techniques. AJR Am J Roentgenol 2017; 208 (05) 1134-1140
• 61 Ryan EA, Paty BW, Senior PA, Shapiro AM. Risks and side effects of islet transplantation. Curr Diab Rep 2004; 4 (04) 304-309
• 62 Ryan EA, Paty BW, Senior PA. , et al. Five-year follow-up after clinical islet transplantation. Diabetes 2005; 54 (07) 2060-2069
• 63 Markmann JF, Rosen M, Siegelman ES. , et al. Magnetic resonance-defined periportal steatosis following intraportal islet transplantation: a functional footprint of islet graft survival?. Diabetes 2003; 52 (07) 1591-1594
• 64 Hering BJ, Clarke WR, Bridges ND. , et al; Clinical Islet Transplantation Consortium. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Diabetes Care 2016; 39 (07) 1230-1240