Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Patel, Shaneel; Hakim, Nadey

doi:10.6002/ect.2012.0003

Cited by 10 publications

(12 citation statements)

References 43 publications

(48 reference statements)

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“…In multivariate analysis, platelet dysfunction along with enteric drainage and WIT was predictive of graft thrombosis (Table ). Enteric drainage has been previously identified as a risk factor for allograft thrombosis . Unexpectedly, WIT and not cold ischemia time were associated with graft thrombosis, possibly due to technical issues at the time of implantation.…”

Section: Discussionmentioning

confidence: 91%

Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Raveh

Ciancio

Burke

et al. 2019

Clinical Transplantation

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Pancreas transplant achieves consistent long-term euglycemia in type 1 diabetes.Allograft thrombosis (AT) causes the majority of early graft failure. We compared outcomes of four anticoagulation regimens administered to 95 simultaneous kidney-pancreas or isolated pancreas transplanted between 1/1/2015 and 11/20/2018. Early postoperative anticoagulation regimens included the following: none, subcutaneous heparin/aspirin, with or without dextran, and heparin infusion. The regimens were empirically selected based on each surgeon's assessment of hemostasis of the operative field and personal preference. A sonographic-based global scoring system of AT is presented. The 47-month recipients and graft survival were 95% and 86%, respectively. Recipients with or without AT had similar survival. Five and four grafts were lost due to death and AT, respectively. Outcomes of prophylaxis regimens correlated with intensity of anticoagulation. Compared with no anticoagulation, an increase in hemorrhagic complications occurred exclusively with iv heparin. The higher arterial AT score found in regimens lacking antiplatelet therapy highlights the importance of early antiaggregants therapy. Abnormal fibrinolysis was associated with an increase in AT score. Platelet dysfunction, warm ischemia time, and enteric drainage were predictive of AT and, along with other known risk factors, were incorporated into an algorithm that matches intensity of early postoperative anticoagulation to the thrombotic risk.

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Section: Discussionmentioning

confidence: 91%

Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Raveh

Ciancio

Burke

et al. 2019

Clinical Transplantation

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“…3 Other significant risk factors include type of preservation solution (reduced risk with UW), prolonged cold ischemia time (CIT), and technical factors during procurement and implantation. 2,7 Rate of graft loss secondary to PAT has been reported as 4% to 8% after simultaneous pancreaskidney transplantation (SPK) and 10% to 12% after solitary pancreatic transplantation (SPT). 8 Imaging plays a vital role in the evaluation of the transplanted pancreas.…”

mentioning

confidence: 99%

Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm

Hakeem

Chen

Iype

et al. 2018

American Journal of Transplantation

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Pancreatic allograft thrombosis (PAT) remains the leading cause of nonimmunologic graft failure. Here, we propose a new computed tomography (CT) grading system of PAT to identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplantations between 2009 and 2014. Triple‐phase CT scans were graded independently by 2 radiologists as grade 0, no thrombosis; grade 1, peripheral thrombosis; grade 2, intermediate non‐occlusive thrombosis; and grade 3, central occlusive thrombosis. Twenty‐four (23.3%) of 103 recipients were diagnosed with PAT (including grade 1). Three (2.9%) grafts were lost due to portal vein thrombosis. On multivariate analysis, pancreas after simultaneous pancreas–kidney transplantation/solitary pancreatic transplantation, acute rejection, and CT findings of peripancreatic edema and/or inflammatory change were significant risk factors for PAT. Retrospective review of CT scans revealed more grade 1 and 2 thromboses than were initially reported. There was no significant difference in graft or patient survival, postoperative stay, or morbidity of recipients with grade 1 or 2 thrombosis who were or were not anticoagulated. Our data suggest that therapeutic anticoagulation is not necessary for grade 1 and 2 arterial and grade 1 venous thrombosis. The proposed grading system can assist clinicians in decision‐making and provide standardized reporting for future studies.

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“…Because of the pancreatic vulnerability to vascular complications and because of the inherently intrapancreatic low microvascular flow and hypercoagulable blood of diabetic persons, patients were started early on maintenance acetylsalicylic acid. 9 …”

Section: Discussionmentioning

confidence: 99%

Successful Combined Pancreas Fourth-Kidney Third and Pancreas Third-Kidney Second Transplantation

Bösmüller

Maglione

Margreiter

et al. 2015

Transplantation Direct

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BackgroundExtremely few reports have been published on experience with multiple combined pancreas-kidney re-transplantation including long-term results. We here analyze our experience with two patients following successful combined pancreas fourth-kidney third and pancreas third-kidney second transplantation.MethodsPatient and graft survival as well as graft function and major complications were recorded. Patient 1 (women, 47 years) underwent combined pancreas fourth-kidney third transplantation after previous removal of the first and second renal and the second pancreatic grafts. Patient 2 (men, 51 years) underwent combined pancreas third-kidney second transplantation after nephrectomy of the first renal graft. Immunosuppression consisted of induction with alemtuzumab and maintenance with tacrolimus, mycophenolate mofetil/mycophenolic acid and steroids.ResultsAfter a follow-up of 44 and 49 months, respectively, both patients are doing well with stable graft function. Leukopenia, thrombocytopenia, bacterial sepsis, and chronic hepatitis C as major complications were controllable.ConclusionsMultiple pancreas-retransplantations combined with simultaneous renal transplantation are feasible. Meticulous immunosuppression, careful monitoring, and excellent patient adherence are of crucial importance.

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Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Cited by 10 publications

References 43 publications

Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm

Successful Combined Pancreas Fourth-Kidney Third and Pancreas Third-Kidney Second Transplantation

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