Islet transplantation is being offered increasingly for selected patients with unstable type 1 diabetes.
Percutaneous transhepatic portal access avoids a need for surgery, but is associated with potential risk of bleeding.
Between 1999 and 2005, Dr James Shapiroa and colleagues from Alberta performed 132 percutaneous transhepatic islet transplants in 67 patients.
The research team encountered bleeding in 14% of cases.
In univariate analysis, the risk of bleeding in the absence of effective track ablation was associated with an increasing number of procedures.
The researchers also found that bleeding risk was associated with platelets count less than 150 000, and elevated portal pressure.
| The intrahepatic portal catheter was sealed using thrombostatic coils and tissue fibrin glue|
|American Journal of Transplantation|
An increased risk of bleeding without track ablation was associated with a heparin dose of 45 U/kg or more and pre-transplant aspirin of 81 mg per day.
A multivariate analysis further confirmed the cumulative transplant procedure number as an independent risk factors for bleeding.
The researchers noted that heparin dose equal to or more than 45 U/kg as independent risk factors for bleeding.
The team observed effective mechanical sealing of the intrahepatic portal catheter tract completely prevented bleeding in all subsequent procedures.
Sealing of the intrahepatic portal catheter was done using thrombostatic coils and tissue fibrin glue.
Dr Shapiroa's team concluded, “We conclude that bleeding after percutaneous islet implantation is an avoidable complication provided the intraparenchymal liver tract is sealed effectively.”