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Surgical Technique Cuts Islet Cell Transplant Complications
TUESDAY, Nov. 29 (HealthDay News) -- A new surgical procedure dubbed the "sandwich technique" reduces the risk of complications from islet cell transplantation, a procedure to help diabetics who don''t produce enough insulin. In a small study, researchers at the University of Minnesota report that the procedure resulted in less internal bleeding, no blood clots and no blood infections in patients undergoing islet cell transplantation. All 13 people included in the study also began producing insulin on their own and were able to stop injecting insulin to control their blood sugar. "This study was part of a larger multi-center trial on islet cell transplantation that has found after one year that 80 percent [of participants] don''t need insulin any more," said study co-author Dr. Saravanan Krishnamoorthy, a radiology resident at the University of Minnesota in Minneapolis. He noted that "the techniques used in each center were a little bit different -- some people just use coils, some just use foam, and some just use pressure." The procedure is not without risk, however. "There have been bleeding complications in a significant number of patients," he said. In their study, Krishnamoorthy''s team used a procedure that used both the tiny coils and a gel foam. The findings were presented Tuesday at the Radiological Society of North America''s annual meeting in Chicago. In type 1 diabetes, the islet cells in the pancreas produce little or no insulin, which means the body can''t process glucose -- blood sugar -- properly. The standard treatment for this form of diabetes is injections of insulin to replace the insulin the body is no longer producing. However, some people have very difficult-to-control diabetes, and can''t maintain a good balance between insulin and blood sugar. For these people, islet cell transplantation may be an option. In islet cell transplantation, as many as 1 million islet cells are removed from a cadaver pancreas, according to experts at the American Diabetes Association. Using ultrasound to visualize the liver, a surgeon guides a catheter into the transplant recipient''s liver and then injects the islet cells into the liver. Internal bleeding is a possible complication from this procedure. In time, some of the islet cells begin producing insulin. In many cases, the transplant recipient no longer needs to take insulin. Success rates vary, however. Transplant recipients must also take powerful immune-system suppressing medications for the rest of their lives. Because the long-term side effects of these drugs aren''t known, the procedure is only recommended for those who can''t maintain good blood sugar control and face serious complications from uncontrolled diabetes. In the new study, the researchers looked at one small aspect of islet cell transplantation -- how to reduce the complications associated with the procedure itself. To that end, they combined surgical closing techniques and created the "sandwich technique." "After you inject the islet cells, you put in a series of coils to slow the bleeding, then foam, then another coil, then foam, and on and on until the bleeding stops or you reach the skin," Krishnamoorthy said. "It''s a very simple technique that seems to prevent bleeding." He and his colleagues used the procedure on 13 patients. Only one had any significant problems, and those were due to the inexperience of the technician who performed the transplant, according to Krishnamoorthy. Dr. Bernard Degnan, a pediatric endocrinologist at William Beaumont Hospital in Royal Oak, Mich., was cautiously optimistic about the study results. "This is exciting news, but the main thing from my perspective is that this is not something we can offer to most patients just yet," he said. "Parents are often disappointed to hear that. But for otherwise healthy children, this is not an option because of the risk-benefit assessment. If safer immunosuppressant drugs are developed, then that kind of treatment would be appropriate," Degnan said, but added that it may be at least 15 to 20 years before such drugs might be available. More information To learn more about islet cell transplantation, visit the American Diabetes Association.
Last Updated: Nov. 29, 2005 |