Cell Transplantation & Gene Therapy Institute, Third Xiangya Hospital, Changsha 410013, China.
Hepatobiliary Pancreat Dis Int. 2012 Apr;11(2):154-9. doi: 10.1016/s1499-3872(12)60141-6.
Pig islet xenotransplantation has the potential to overcome the shortage of donated human islets for islet cell transplantation in type 1 diabetes. Testing in non-human primate models is necessary before clinical application in humans. Intraportal islet transplantation in monkeys is usually performed by surgical infusion during laparotomy or laparoscopy. In this paper, we describe a new method of percutaneous transhepatic portal catheterization (PTPC) as an alternative to current methods of islet transplantation in rhesus monkeys.
We performed ultrasound-guided PTPC in five adult rhesus monkeys weighing 7-8 kg, with portal vein catheterization confirmed by digital subtraction angiography. We monitored for complications in the thoracic and abdominal cavity. To evaluate the safety of ultrasound-guided PTPC, we recorded the changes in portal pressure throughout the microbead transplantation procedure.
Ultrasound-guided PTPC and infusion of 16 000 microbeads/kg body weight into the portal vein was successful in all five monkeys. Differences in the hepatobiliary anatomy of rhesus monkeys compared to humans led to a higher initial complication rate. The first monkey died of abdominal hemorrhage 10 hours post-transplantation. The second suffered from a mild pneumothorax but recovered fully after taking only conservative measures. After gaining experience with the first two monkeys, we decreased both the hepatic puncture time and the number of puncture attempts required, with the remaining three monkeys experiencing no complications. Portal pressures initially increased proportional to the number of transplanted microbeads but returned to pre-infusion levels at 30 minutes post-transplantation. The changes in portal pressures occurring during the procedure were not significantly different.
Ultrasound-guided PTPC is an effective, convenient, and minimally invasive method suitable for use in non-human primate models of islet cell transplantation provided that care is taken with hepatic puncture. Its advantages must be weighed against the risks of procedure-related complications.
猪胰岛异种移植有可能克服 1 型糖尿病胰岛细胞移植中供体人胰岛短缺的问题。在临床应用于人体之前，需要在非人类灵长类动物模型中进行测试。在猴子中，门静脉内胰岛移植通常通过剖腹手术或腹腔镜手术进行手术输注。本文描述了一种新的经皮经肝门静脉穿刺（PTPC）方法，作为替代目前恒河猴胰岛移植方法的选择。
我们对 5 只体重 7-8 公斤的成年恒河猴进行了超声引导下的 PTPC，通过数字减影血管造影术确认门静脉导管插入。我们监测了胸腔和腹腔的并发症。为了评估超声引导下 PTPC 的安全性，我们记录了整个微球移植过程中门静脉压力的变化。
超声引导下的 PTPC 和将 16000 个微球/公斤体重输注到门静脉在所有 5 只猴子中均成功。恒河猴与人类的肝胆解剖差异导致初始并发症发生率较高。第一只猴子在移植后 10 小时死于腹腔出血。第二只猴子患有轻度气胸，但仅采取保守措施后完全康复。在前两只猴子获得经验后，我们减少了肝穿刺时间和穿刺次数，其余 3 只猴子没有发生并发症。门静脉压力最初与移植的微球数量成正比增加，但在移植后 30 分钟恢复到输注前水平。手术过程中门静脉压力的变化没有显著差异。
超声引导下的 PTPC 是一种有效、方便、微创的方法，适用于胰岛细胞移植的非人类灵长类动物模型，但需要注意肝穿刺。必须权衡与程序相关的并发症风险。
