Islet Transplant Surgery

Islets for transplantation come from someone who has had an accident or medical event which has led to brain death. The donor's family has made the decision to donate this person's organs for transplant.

Preparing the Islets

The isolation procedure must begin within hours after the donor pancreas is procured. The process takes place in the Emory Islet Isolation Laboratory and requires a team of four to five highly trained people.

Isolating and preparing the islets for transplant takes eight to 12 hours. A catheter is placed into the ductal system of the pancreas, and an enzyme is injected into the gland. The enzyme breaks down the connections between the cells of the pancreas. The pancreas is then placed in a special chamber with marbles. Fluid is pumped in and out of the chamber as it is shaken. The pancreas is broken down into tiny pieces of tissue, and the islet tissue is separated from the rest of the pancreatic tissue. If a sufficient number of islets are isolated, they are prepared for transplant and the patient is prepared for surgery. If there are not enough islets in the final count, the transplant will be cancelled and the patient will be sent home. A patient could be called to the hospital several times before receiving a transplant, since the number of islets available is not known until the end of the isolation process.

The Islet Transplant

The patient will be given his or her first dose of immunosuppressants right before the transplant procedure. The transplant procedure may take place in the operating room or in Interventional Radiology and is performed by a transplant surgeon. In the Operating Room, general anesthesia is used, and the patient is asleep for the entire procedure. In Interventional Radiology, sedation is used.

Surgical Procedure:

The abdomen is washed with disinfectant and draped with sterile towels. The surgeon makes an incision in the abdomen. A catheter (thin plastic tube) is placed into a vein, and a bag containing the islets is attached to this catheter. The islets flow into the vein and are carried by the blood flow into the liver, where they lodge in smaller veins and capillaries. The infusion takes 15 to 30 minutes; the entire surgery takes up to two hours.

Interventional Radiology Procedure:

The skin on the right side of your chest (in between your lower ribs) will be cleaned to make it sterile. A numbing medicine will be injected into a small area of skin on your right side. Then, a radiologist will use ultrasound, X-rays, or CT scan to guide the needle during the procedure. The radiologist will inject dye to help find the main vein that carries blood from the intestines to the liver (the portal vein). After identifying the vein, the radiologist will place a thin plastic tube into the vein. The islets will be injected slowly through this tube and carried by the blood into the liver.

Once the islet infusion is complete, the catheter is removed and the incision is closed using sutures or staples. Once the patient is awake, he or she is transported to the recovery room and monitored for about an hour. After returning to the hospital room, the nursing staff continues to monitor the patient's vital signs and blood sugars frequently. After about six hours, blood is drawn for labwork. An abdominal ultrasound is performed within 24 hours after the transplant to check the liver for bleeding around the blood vessel where the islets were infused. If all the test results are satisfactory, the patient is discharged from the hospital two days after the transplant.