Early protocol computer tomography and endovascular interventions in pancreas transplantation

Abstract

Background Early vascular complications following pancreatic transplantation are not uncommon (3%–8%). Typically, cross‐sectional imaging is requested in response to clinical change. We instituted a change in protocol to request imaging pre‐emptively to identify patients with thrombotic complications. Methods In 2013, protocol computer tomography angiography (CTA) at days 3–5 and day 10 following pancreas transplantation was introduced. A retrospective analysis of all pancreas transplants performed at our institution from January 2001 to May 2019 was undertaken. Results A total of 115 patients received pancreas transplants during this time period. A total of 78 received pancreas transplant without routine CTA and 37 patients with the new protocol. Following the change in protocol, we detected a high number of subclinical thromboses (41.7%). There was a significant decrease in invasive intervention for thrombosis (78.6% before vs 30.8% after, p = .02), and graft survival was significantly higher (61.5% before vs 86.1% after, p = .04). There was also a significant reduction in the number of graft failures (all‐cause) where thrombosis was present (23.4% before vs 5.6% after, p = .02). Patient survival was unaffected (p = .48). Conclusions Implementation of early protocol CTA identifies a large number of patients with subclinical graft thromboses that are more amenable to conservative management and significantly reduces the requirement for invasive intervention.

First‐day plasma amylase detects patients at risk of complications after simultaneous pancreas‐kidney transplantation

“…However, as a tradeoff, the susceptibility for hemorrhage increased, contributing to our high relaparotomy rate for hemorrhage. Our overall relaparotomy rate (24%), however, is at the lower end compared with reported cohorts, and our graft loss rate is very low (3.0% during the first 12 months) 4,6–10 …”

“…Our overall relaparotomy rate (24%), however, is at the lower end compared with reported cohorts, and our graft loss rate is very low (3.0% during the first 12 months). 4,[6][7][8][9][10] It might be argued that using plasma amylase to predict pancreatitis or pancreas graft-related complications is biased because pancreatitis elevates plasma amylase levels. 19 However, in our cohort, clinically overt graft pancreatitis requiring relaparotomy was observed at 8th postoperative day the earliest and on average at 19th postoperative day, and thus, we believe that first-day plasma amylase is a relatively specific marker for pancreatic tissue injury manifesting later as pancreatitis.…”

“…Majority of the complications are related to the pancreas allograft and include hemorrhage, vascular thrombosis, graft pancreatitis, intra-abdominal infections, pancreatic fistula, peripancreatic fluid collections, and anastomotic leakage 6 . Early relaparotomy rates reported in previous studies range from 23% to 44%, and first month pancreas graft loss-rates range from 3.1% to 18% 4,[6][7][8][9][10] .…”

“…6 Early relaparotomy rates reported in previous studies range from 23% to 44%, and first-month pancreas graft loss rates range from 3.1% to 18%. 4,[6][7][8][9][10] Most previous studies have focused on examining the incidence of early complications, or the effect of early complications on the long-term patient and graft survival. 4,6,11 However, the knowledge on early warning signs and surrogate markers for postoperative complications is still scarce.…”

Effect of donor pancreas extraction time on pancreas transplantation—a Swiss tertiary center experience

“…The rate of relaparotomy was high, however in line with previously published data. 40,[43][44][45][46][47] However, complications in general and even loss of the pancreas graft did not negatively affect Regarding graft pancreatitis in our cohort, ET and CIT did not affect post-transplant amylase levels and incidence of graft pancreatitis. This is consistent with the finding of Humar et al that prolonged CIT had no negative effect on the incidence of pancreatitis after PT, 7 although with different definitions of graft pancreatitis.…”