To evaluate the safety and efficacy of modified percutaneous transhepatic portal vein islet cell transplantation.

Clinical data of 46 patients undergoing percutaneous transhepatic portal vein islet cell transplantation in Shanghai Changzheng Hospital Affiliated to Naval Medical University from December 2016 to June 2020 were retrospectively analyzed. Among them, 34 patients were male and 12 female, aged from 13 to 74 years, with a median age of 49 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different surgical methods, all patients were divided into the conventional intervention group (conventional group, n=25) and modified intervention group (modified group, n=27). In the conventional group, infusion of islet cells was performed with F single-curved arteriographic catheter under real-time pressure monitoring, and the puncture channel was blocked up with steel ring and gelfoam particles. In the modified group, PTCD catheter infusion with manually-cutted inner core was performed under intermittent pressure monitoring, and the puncture channel was blocked up with gelfoam particles. The operation time and portal pressure between two groups were compared by using t test and the rate comparison was analyzed by Chi-square test.

46 patients successfully completed 52 times of islet cell transplantation, with a success rate of 100%. Among them, 2 recipients received twice transplantation in the conventional group and 4 in the modified group. The operation time in the conventional and modified group was (124±14) and (110±17) min, respectively, where no significant difference was observed (t=1.35,P>0.05). In the conventional group, the portal vein pressure before and after transplantation were (13±4) and (12±3) mmHg (1 mmHg=0.133 kPa), and (16±3) and (14±5) mmHg in the modified group, where no significant difference was observed between portal vein pressures before and after operation (t=0.34, 0.87;P>0.05). 1 case developed postoperative thoracic hemorrhage in the conventional group and 1 case of intrahepatic hematoma in the modified group, and both were healed after conservative treatments. The incidence of bleeding was 4%(1/25) and 4%(1/27) respectively in the conventional and modified groups, with no significant difference (χ²=0.45,P>0.05). The insulin-free rate in the recipients undergoing initial islet cell transplantation within 6 months was 60%(15/25) and 66%(18/27) respectively in the conventional and modified groups, with no significant difference (χ²=5.32,P>0.05). In the conventional and modified groups, the fasting C-peptide increment was (0.22±0.07) and (0.19±0.06) nmol/L, respectively, and the 2 h postprandial C-peptide increment was (0.67±0.20) and (0.53±0.17) nmol/L, respectively, with no significant differences (t=1.362, 1.722;P>0.05).

Compared with the conventional surgery, the modified percutaneous transhepatic portal vein islet cell transplantation is equally safe and efficacious, which possess multiples advantages of less use of intrahepatic steel ring and no artifacts in the postoperative imaging examination.