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ABSTRACT: The distribution of radiolabeled polyvinyl alcohol microspheres (PVAMs) when infused into the portal vein of domestic swine
was investigated, with the purpose of assessing implications for pancreatic islet cell transplantation. PVAMs measuring 100–300μm
(Contour SE) and labeled with 99mTc were infused into the main portal vein of 12 swine, with intermittent portal venous pressure measurements. The infusion
catheter was introduced antegradely via direct or indirect cannulation of the portal vein. The liver was subsequently divided
into anatomical segments. Radioactivity (decay corrected) was measured for 99mTc microsphere synthesis, dose preparation, gross organ activities, tissue samples, and blood. Particulate labeling, catheter
positioning, and infusion were successful in all cases. The number of particles used was (185,000±24,000) with a volume
of 1ml. Mean portal pressure at 5min was significantly higher than baseline, but without a significant difference at 15min.
Extrahepatic tissue and serum radioactivity was negligible. A significant difference in number of radioactive particles per
gram was detected between segments 6/7 and segments 5/8. Intrasegmental activity was analyzed, and for segments 2/3 a significant
difference in the percentage dose per gram across samples was demonstrated (P=0.001). Effective and stable radiolabeling of PVAMs with 99mTc-sulfur colloid was demonstrated. Portal venous infusion of 100- to 300-μm particles showed entrapment in the sinusoidal
hepatic system with transient portal pressure elevation. Preferential embolization into the right lateral and posterior segments
occurs, suggesting that flow dynamics/catheter tip position plays a role in particle distribution.
CardioVascular and Interventional Radiology 04/2012; 32(3):499-507. · 2.09 Impact Factor
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Pancreas 11/2006; 33(3):316-7. · 2.39 Impact Factor
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ABSTRACT: Sirolimus (SRL) has been used for most islet recipients over the past 5 years. It provides balanced immunosuppression in combination with low-dose calcineurin inhibitors, while avoiding corticosteroids. This regimen decreases the risk of nephrotoxicity, neurotoxicity and diabetogenicity. SRL has also been used selectively in clinical liver and kidney transplantation. A number of common side effects including anemia, leucopenia, thrombocytopenia, hypercholesterolemia, mouth ulceration, joint pain, extremity edema and impaired wound healing have been associated with the use of SRL. As SRL is used more frequently, evidence has been gathered on its rare but severe side effects. We report 2 patients who underwent islet transplantation and developed symptomatic small bowel ulceration that resolved after complete withdrawal of SRL. Although small bowel ulceration is rare, it can potentially progress to more serious complications if not treated adequately. Our experience highlights an uncommon but potentially serious adverse effect of high-dose SRL in islet recipients.
American Journal of Transplantation 12/2005; 5(11):2799-804. · 6.39 Impact Factor
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[show abstract]
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ABSTRACT: Sirolimus (SRL) has been used for most islet recipients over the past 5 years. It provides balanced immunosuppression in combination with low-dose calcineurin inhibitors, while avoiding corticosteroids. This regimen decreases the risk of nephrotoxicity, neurotoxicity and diabetogenicity. SRL has also been used selectively in clinical liver and kidney transplantation. A number of common side effects including anemia, leucopenia, thrombocytopenia, hypercholesterolemia, mouth ulceration, joint pain, extremity edema and impaired wound healing have been associated with the use of SRL. As SRL is used more frequently, evidence has been gathered on its rare but severe side effects. We report 2 patients who underwent islet transplantation and developed symptomatic small bowel ulceration that resolved after complete withdrawal of SRL. Although small bowel ulceration is rare, it can potentially progress to more serious complications if not treated adequately. Our experience highlights an uncommon but potentially serious adverse effect of high-dose SRL in islet recipients.
American Journal of Transplantation 10/2005; 5(11):2799 - 2804. · 6.39 Impact Factor
