Use of D-Stat^TM to Prevent Bleeding Following Percutaneous Transhepatic Intraportal Islet Transplantation

Authors: Froud T.¹; Yrizarry J.M.²; Alejandro R.³; Ricordi C.¹

Source: Cell Transplantation, Volume 13, Number 1, 2004 , pp. 55-59(5)

Publisher: Cognizant Communication Corporation

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Abstract:

An infrequent but nevertheless concerning complication associated with percutaneous transhepatic islet transplantation is bleeding. Historically in 61 procedures at this institution, we experienced four bleeding complications in three patients (6.6%), two requiring blood transfusion (3.3%) and two asymptomatic intraperitoneal bleeds detected sonographically at 24 h postprocedure (3.3%). It is suggested that the source of the majority of these bleeds is the liver parenchymal tract following removal of the infusion catheter combined with a significant dose of heparin administered to prevent portal vein thrombosis. Various techniques have been used to reduce the risk of tract bleeding, including gelfoam, intravascular coils, and cautery. In our experience gelfoam alone has been used to plug the catheter tract (n = 47); however, in the aforementioned three patients, this technique failed, either due to dislodgement of, or bleeding peripheral to, the plug. This article describes the use of D-Stat^TM, a collagen/thrombin paste that is injected into the peripheral tract. In five consecutive cases performed using D-Stat^TM, there has been no bleeding or thromboses detected. D-Stat^TM combined with a single gelfoam plug offers a quick, easy, efficacious way of sealing the entire catheter tract without leaving any permanent hardware in the liver. This new method may simplify tract closure and reduce bleeding complications in islet transplantation.

Keywords: D-StatTM; Percutaneous transhepatic islet transplantation; Bleeding; Gelfoam plugs

Document Type: Research article

Affiliations: 1: *University of Miami, *Cell Transplant Division of Surgery, Miami, FL 33136 2: †University of Miami, Department of Radiology, Miami, FL 33136 3: ‡University of Miami, Department of Medicine, Miami, FL 33136

Publication date: 2004-01-01

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Cell Transplantation publishes original, peer-reviewed research and review articles on the subject of cell transplantation and its application to human diseases. To ensure high-quality contributions from all areas of transplantation, separate section editors and editorial boards have been established. Articles deal with a wide range of topics including physiological, medical, preclinical, tissue engineering, and device-oriented aspects of transplantation of nervous system, endocrine, growth factor-secreting, bone marrow, epithelial, endothelial, and genetically engineered cells, among others. Basic clinical studies and immunological research papers are also featured. To provide complete coverage of this revolutionary field, Cell Transplantation will report on relevant technological advances, and ethical and regulatory considerations of cell transplants. Cell Transplantation is now an Open Access journal starting with volume 18 in 2009, and therefore there will be an inexpensive publication charge, which is dependent on the number of pages, in addition to the charge for color figures. This will allow work to be disseminated to a wider audience and also entitle the corresponding author to a free PDF, as well as prepublication of an unedited version of the manuscript.

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