The islet transplant waiting list
Once enrolled in the program, the wait for a suitable islet preparation begins. It may take more than 6 months before a suitable islet preparation becomes available. It is important that the patient be contactable at all times.
The call to come into hospital can be associated with mixed emotions including anxiety, fear and excitement. Patients are encouraged to have a pre-packed bag in anticipation of the call to come into hospital.
During “the call” the patient will be asked if they have had any recent medical issues that may make them temporarily unsuitable for transplantation such as infection.
The islet transplant procedure
After arrival in hospital the patient will be directed to the transplant ward and admitted by the ward nurse and the resident medical staff. They will also be seen by the islet transplant nurse and islet transplant physician to confirm they are fit for islet transplantation.
The procedure is performed under local anaesthetic with mild sedation in the interventional radiology department. The procedure is minimally invasive. A tube is introduced through the skin and guided into the main vein of the liver called the portal vein. The islets are then infused directly into the portal vein. Following the islet infusion the tube is removed, the track filled with polystyrene to avoid bleeding.
Once infused, the islets lodge in the liver and begin to make and release insulin.
Risks associated with islet cell transplantation
There are some risks associated with the transplant, including bleeding from the liver (frequency of 0.6%), which may require a blood transfusion or, uncommonly, an operation to stop the bleeding. In addition, portal vein thrombosis or portal hypertension can occur after islet infusion. Worldwide experience (Clinical Islet Transplant Registry 2014 annual report) is that the majority of procedural adverse events are quickly resolved, with all being eventually resolved. All possible complications associated with the procedure are discussed in detail with the patient well before the transplant.