Changes in portal pressure, blood glucose, and blood pressure levels during islet infusion in pediatric patients: Close monitoring for every five minutes during islet auto-transplantation
Krishna K. Samaga1, Ahad A. Kodipad1, Chandrashekar B. Revanna1, Balamurugan N. Appakalai1, Jaimie D. Nathan1.
1Pediatrics and Surgery, Center for Clinical and Translational Research, Nationwide Children's Hospital / Ohio State University, Columbus, OH, United States
Introduction: Chronic Pancreatitis (CP) is a life debilitating illness in children impairing quality of life and it is associated with incapacitating pain, repeated hospitalizations, and an elevated risk of narcotic dependence. Pediatric patients with severe and intractable chronic pancreatitis, total pancreatectomy (TP) and islet auto-transplant (IAT) may be undertaken. Introducing islets through the portal vein make it susceptible to elevation of portal pressures, portal thrombosis, or bleeding. Close monitoring of portal vein pressure (PVA), CVP, blood pressure for every five-minute during islet infusion by using a computerized manometer placed inline through a three-way stopcock and simultaneous monitoring of blood glucose, and ACT may prevent portal vein thrombosis. This is the first study reporting portal pressure monitoring every five minutes during islet infusion in pediatric patients.
Methods: Pediatric patients underwent total pancreatectomy followed by islet auto-transplantation (n=25). Human islets were isolated following young donor islet isolation protocol for CP pancreas. Unpurified islets were infused into portal vein and PVA, CVP, blood pressure, blood glucose, and ACT were monitored for every five minutes throughout the islet infusion in operating room.
Results: Blood glucose (BG) levels were well controlled (below 180mg/dL) during islet infusion due to close monitoring of BG every five minutes. Drop in BG levels due to dumping insulin from infused islets was not observed. The average pancreas weight was 46 grams. Patients received a mean islet dose of 6368 IEQ per kg body weight, corresponding to a tissue volume of 9.4ml. Elevation in portal pressure was observed during infusion of >0.25ml tissue/kg body weight of recipient. Every five-minute monitoring allowed us to carefully assess portal vein pressure (PVA), CVP, blood pressure, blood glucose and ACT levels and control their levels.
Conclusion: This is the first report, monitored several key parameters for every five-minute during islet cell infusion and improved our understanding of blood glucose, blood pressure and portal pressure changes. This method of slow infusion and frequent monitoring helped to prevent adverse reaction.
