Massimo Venturini, Presenter: Nothing to Disclose

Paola Maffi, Abstract Co-Author: Nothing to Disclose

Enzo Angeli, Abstract Co-Author: Nothing to Disclose

Federico Bertuzzi, Abstract Co-Author: Nothing to Disclose

Antonio Secchi, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Pancreatic-islets represent an alternative to whole-pancreas transplantation in diabetic kidney-transplanted patients (IAK). Recently, islets-alone (ITA) transplantation (Edmonton Protocol) has been adopted for non-uremic patients to prevent diabetic complications, with a different immunosuppressive regimen. Our aim was to compare IAK and ITA regarding technical feasibility, complications and clinical outcomes.

Ultrasonography and fluoroscopy-guided intraportal islets transplantation was performed in 24 kidney-transplanted (IAK) and 11 non-uremic (ITA) diabetic patients. Immunosuppression was based on cyclosporine, azathioprine, mycophenolate-mofetil and low-dose-steroids for IAK and on a steroid-free regimen (sirolimus, tacrolimus) for ITA. For each procedure were evaluated technical success, number of puncture attempts, complications and, at one year, the following clinical outcomes: well-function (C-peptide>0.5 ng/ml), Insulin-independence, Transaminases, Creatinine, Urinary Albumin Excretion (UAE).

The success of percutaneous procedure was 100%, with a single-puncture attempt in 90% of the cases. Procedure-linked complications were: 1 peripheral portal thrombosis (ITA), 1 candida infection (IAK), 2 hemoperitoneum (1-IAK, 1-ITA). IAK and ITA showed similar 1-year rate of well-function and Insulin- independence (IAK:58%, ITA:62%).Transaminases were significantly higher in IAK than ITA at 1 month, normalizing during the follow-up. Creatinine and UAE were stable after islets transplantation (excepted 2 ITA with pre-existing mild nephropathy, in which they increased).

Percutaneous intraportal islets transplantation is a safe, low-complicated procedure using a combined ultrasonography and fluoroscopy-guided technique. A similar clinical outcome was found in IAK and ITA patients.

Venturini, M, Maffi, P, Angeli, E, Bertuzzi, F, Secchi, A, Del Maschio, A, Percutaneous Intrahepatic Transplantation of Islets after Kidney (IAK) and Islets Alone (ITA) in 34 Type I Diabetic Patients: Technical Aspects, Complications, and Clinical Outcomes.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4419008.html