The First Case of Intra-portal Islet Implantation During Liver Machine Perfusion Allowing Simultaneous Islet-liver Transplantation in A Human: A New and Safe Treatment for End-stage Liver Disease Combined With Diabetes Mellitus

Qiang Zhao; Jiahao Li; Zepeng Lin; Yunhua Tang; Daopeng Yang; Meiting Qin; Xue Ma; Haibin Ji; Honghui Chen; Tielong Wang; Maogen Chen; Weiqiang Ju; Dongping Wang; Zhiyong Guo; Xiaofeng Zhu; Jia Dan; Anbin Hu; Xiaoshun He

doi:10.1097/SLA.0000000000006526

The First Case of Intra-portal Islet Implantation During Liver Machine Perfusion Allowing Simultaneous Islet-liver Transplantation in A Human: A New and Safe Treatment for End-stage Liver Disease Combined With Diabetes Mellitus

Ann Surg. 2024 Sep 9. doi: 10.1097/SLA.0000000000006526. Online ahead of print.

Authors

Qiang Zhao^{1

2

3}, Jiahao Li^{1

2

3}, Zepeng Lin^{1

2

3}, Yunhua Tang^{1

2

3}, Daopeng Yang^{1

2

3}, Meiting Qin^{1

2

3}, Xue Ma^{1

2

3}, Haibin Ji^{1

2

3}, Honghui Chen^{1

2

3}, Tielong Wang^{1

2

3}, Maogen Chen^{1

2

3}, Weiqiang Ju^{1

2

3}, Dongping Wang^{1

2

3}, Zhiyong Guo^{1

2

3}, Xiaofeng Zhu^{1

2

3}, Jia Dan^{1

2

3}, Anbin Hu^{1

2

3}, Xiaoshun He^{1

2

3}

Affiliations

¹ Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
³ Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China.

PMID: 39247951
DOI: 10.1097/SLA.0000000000006526

Abstract

Objective: Evaluating the safety and efficacy of implanting a liver with islet grafts into patients with end-stage liver disease and diabetes mellitus (DM).

Background: DM and end-stage liver diseases are significant health concern worldwide, often coexisting and mutually influencing each other. Addressing both diseases simultaneously is paramount.

Methods: We utilized the islet transplantation combined ischemia-free liver transplantation (ITIFLT) technique to treat a patient with hepatocellular carcinoma (HCC) and type 2 diabetes mellitus (T2DM). The liver was procured and preserved using the ischemia-free liver transplantation (IFLT) technique, and during normothermic machine perfusion (NMP), isolated and purified islet grafts were transplanted into the liver through the portal vein. Finally, the liver, incorporating with the transplant islet grafts, was implanted into the recipient without interruption of blood supply.

Results: The patient received both liver and islet graft from the same donor. The patient achieved insulin-independence by post-transplant day (PTD) 9, and both liver and islet function remained robust. The patient was discharged on PTD 18 and experienced no surgical or transplantation-related complications during the follow-up period. Furthermore, islet grafts presence was observed in liver biopsies after islet transplantation.

Conclusions: This landmark case marks the inaugural application of ITIFLT in humans, signifying its potential as a promising treatment modality for end-stage liver disease with DM.