Department of aSurgery, University of Alberta, Edmonton, Alberta, Canada.
Am J Transplant. 2011 Dec;11(12):2700-7. doi: 10.1111/j.1600-6143.2011.03717.x. Epub 2011 Aug 29.
Percutaneous transhepatic portal access avoids surgery but is rarely associated with bleeding or portal venous thrombosis (PVT). We herein report our large, single-center experience of percutaneous islet implantation and evaluate risk factors of PVT and graft function. Prospective data were collected on 268 intraportal islet transplants (122 subjects). A portal venous Doppler ultrasound was obtained on Days 1 and 7 posttransplant. Therapeutic heparinization, complete ablation of the portal catheter tract with Avitene paste and limiting packed cell volume (PCV) to <5 mL completely prevented any portal thrombosis in the most recent 101 islet transplant procedures over the past 5 years. In the previous cumulative experience, partial thrombosis did not affect islet function. Standard liver volume correlated negatively (r =-0.257, p < 0.001) and PCV correlated positively with portal pressure rise (r = 0.463, p < 0.001). Overall, partial portal thrombosis occurred after 10 procedures (overall incidence 3.7%, most recent 101 patient incidence 0%). There were no cases of complete thrombosis and no patient developed sequelae of portal hypertension. In conclusion, portal thrombosis is a preventable complication in clinical islet transplantation, provided therapeutic anticoagulation is maintained and PCV is limited to <5 mL.
经皮经肝门静脉入路避免了手术，但很少与出血或门静脉血栓形成（PVT）相关。我们在此报告我们的大型单中心经皮胰岛移植经验，并评估 PVT 和移植物功能的危险因素。前瞻性数据收集了 268 例门静脉内胰岛移植（122 例患者）。在移植后第 1 天和第 7 天进行门静脉多普勒超声检查。在过去 5 年的 101 例胰岛移植中，使用肝素进行治疗性抗凝、用 Avitene 糊剂完全消融门静脉导管道以及将红细胞压积（PCV）限制在<5 mL，完全防止了任何门静脉血栓形成。在之前的累积经验中，部分血栓形成不会影响胰岛功能。标准肝体积与门静脉压力升高呈负相关（r =-0.257，p <0.001），而 PCV 与门静脉压力升高呈正相关（r = 0.463，p <0.001）。总的来说，10 例（总发生率 3.7%，最近 101 例患者发生率 0%）出现部分门静脉血栓形成。没有完全血栓形成的病例，也没有患者发生门静脉高压的后遗症。总之，在临床胰岛移植中，门静脉血栓形成是可以预防的并发症，只要维持治疗性抗凝，并且将 PCV 限制在<5 mL。
