Coil and gelatin sponge "sandwich" boosts efficacy of islet cell transplantation

Nov 29, 2005

CHICAGO - Interventional radiologists at the University of Minnesota say they have perfected a "sandwich" closure technique that prevents a major complication of intrahepatic islet cell transplantation for treatment of type 1 diabetes.

By using a combination of coil and the absorbable gelatin sponge Gelfoam (Pharmacia & UpJohn Company, Kalamazoo, MI), "we have had only one bleeding complication, and that was really caused by an inexperienced operator who had difficulty getting the correct needle placement in the portal vein," said Dr. Saravanan Krishnamoorthy, a radiology resident at the University of Minnesota in Minneapolis.

However, that was the exception since under ultrasound guidance the portal vein was successfully accessed on the first attempt in more than two-thirds of the cases.

Krishnamoorthy discussed the new closure technique at a press conference Tuesday at the 2005 RSNA conference.

Islet cell transplantation has been developed by an international collaboration known as the Immune Tolerance Network. Since 2000 the University of Minnesota has been working with nine other institutions to perfect the technique but initial transplants were plagued by a number of technical difficulties, including bleeding complications at the access site.

Initially, the interventionalists slowed the blood flow by using coils as the delivery catheter was withdrawn, "that slowed the blood, but it didn't stop the bleeding," Krishnamoorthy said. "We added Gelfoam and that works like a plug to stop the blood flow," he said.

Using this coil and Gelfoam sandwich, the team has completed 21 transplants with only one minor bleeding incident. There were no reports of hemorrhage, hematoma, portal vein thrombosis, or septicemia within the first 30 days. There were no deaths.

"Seventy-one percent of patients did not need insulin at one year," Krishnamoorthy said.

By M. M. Pennell
AuntMinnie.com contributing writer
November 30, 2005