Risk Factors for Thrombosis in Simultaneous Pancreas-Kidney Transplants Performed Over Ten Years at Westmead Hospital

Shahrestani, Sara; Spike, Erin; Hort, Amy; Gibbons, Thomas; Hitos, Kerry; Lendzion, Rebecca; Robinson, Paul A.; Pleass, Henry; Kable, Kathy; Lam, Vincent; Roo, Ronald De; Yuen, Lawrence; Hawthorne, Wayne J.

doi:10.1097/01.tp.0000542917.48792.6b

Cited by 3 publications

(6 citation statements)

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“… 8 , 39 Findings of this review corroborate this, 8 , 20 , 26 , 50 rather, more importantly, one publication even identified an increased thrombotic risk with a donor or recipient BMI ≥ 25 kg/m2 ( P < .05). 46 Preliminary findings of Shahrestani et al 68 identified risk of thrombosis increased by 25.6-fold in male donors compared with females ( P = .01). Recipient gender effect on the risk of thrombosis was poorly reported within the literature.…”

Section: Resultsmentioning

confidence: 93%

“… 6 , 25 , 34 , 70 This is purported to be due to the uremia-induced platelet dysfunction associated with end-stage renal failure.2 Recipient age of less than 45 years has generally been considered representative of an adequate cardiovascular system for immediate graft success and long-term survival. 27 This is highlighted by Shahrestani et al 68 in recipients aged between 37 and 42 years, demonstrating a 10.6 times greater risk of thrombosis compared to those <36 years ( P = .02). Conversely, findings from Gruessner et al6 identify a decreased thrombotic risk with recipients older than 44 years (vs 30-44 years old), warranting further investigation.…”

Section: Discussionmentioning

confidence: 94%

“…In several studies, donor age was associated with increased pancreas allograft thrombosis 6 , 20 , 25 , 45 , 68 and early technical failure. 50 , 57 , 67 Humar et al 25 described a thrombosis incidence of 1.8% with donors younger than 20 years, 3.7% with 20- to 40-year-old donors, and 16.2% with donors older than 40 ( P = .009).…”

Section: Resultsmentioning

confidence: 99%

“…In several studies, donor age was associated with increased pancreas allograft thrombosis 6,20,25,45,68 and early technical failure. 50,57,67 Humar et al 25 Donor and recipient obesity, measured clinically as a BMI > 30 kg/m2, are both widely considered as risk factors for pancreatic allograft thrombosis.…”

Section: Donor and Recipient Factorsmentioning

confidence: 99%

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Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review

Blundell

Shahrestani

Lendzion

et al. 2020

Clin Appl Thromb Hemost

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Simultaneous pancreas-kidney (SPK) transplantation remains the most effective treatment for providing consistent and long-term euglycemia in patients having type 1 diabetes with renal failure. Thrombosis of the pancreatic vasculature continues to contribute significantly to early graft failure and loss. We compared the rate of thrombosis to graft loss and systematically reviewed risk factors impacting early thrombosis of the pancreas allograft following SPK transplantation. We searched the MEDLINE, EMBASE, The Cochrane Library, and PREMEDLINE databases for studies reporting thrombosis following pancreas transplantation. Identified publications were screened for inclusion and synthesized into a data extraction sheet. Sixty-three studies satisfied eligibility criteria: 39 cohort studies, 22 conference abstracts, and 2 meta-analyses. Newcastle-Ottawa Scale appraisal of included studies demonstrated cohort studies of low bias risk; 1127 thrombi were identified in 15 936 deceased donor, whole pancreas transplants, conferring a 7.07% overall thrombosis rate. Thrombosis resulted in pancreatic allograft loss in 83.3% of reported cases. This review has established significant associations between donor and recipient characteristics, procurement and preservation methodology, transplantation technique, postoperative management, and increased risk of early thrombosis in the pancreas allograft. Further studies examining the type of organ preservation fluid, prophylactic heparin protocol, and exocrine drainage method and early thrombosis should also be performed.

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Section: Resultsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Donor and Recipient Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review

Blundell

Shahrestani

Lendzion

et al. 2020

Clin Appl Thromb Hemost

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“…Some reports state that donor obesity is a risk factor for graft thrombosis 14–16 . Preliminary findings suggest that male donors are at higher risk of thrombosis than female donors 17 . Considering these points comprehensively, we hypothesized that the risk of thrombosis associated with donor obesity is not only influenced by the risk of graft steatosis but also by large‐size graft.…”

Section: Introductionmentioning

confidence: 96%

Size‐mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study

Kaku

Okabe

Kubo

et al. 2023

Clinical Transplantation

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IntroductionDonor–recipient (D/R) size mismatch has been evaluated for a number of organs but not for pancreas transplantation.MethodsWe retrospectively evaluated 438 patients who had undergone pancreas transplantation. The D/R body surface area (BSA) ratio was calculated, and the relationship between the ratio and graft prognosis was evaluated. We divided the patients into two groups and evaluated graft survival. The incidence of pancreas graft thrombosis resulting in graft failure within 14 days and 1‐year graft survival were compared using Kaplan–Meier curves, and the prognostic factors associated with graft thrombosis were identified by univariate and multivariate analyses.ResultsThe mean/median donor and recipient BSAs were 1.63 m2/1.65 m2, and 1.57 m2/1.55 m2, respectively; the mean and median D/R BSAs were both 1.05. The receiver operating characteristic curve cutoff for the D/R BSA ratio was 1.09, and significant differences were identified between patients with ratios of ≥1.09 (high group) versus <1.09 (low group). The incidence of graft thrombosis resulting in pancreas graft failure within 14 days was significantly higher in the high group than in the low group (p < .01). One‐year overall and death‐censored pancreas graft survival were significantly higher in the low group than in the high group (p < .01). Multivariate analysis identified recipient height, donor BSA, and donor hemoglobin A1c as significant independent factors for graft thrombosis. Cubic spline curve analysis indicated an increased risk of graft thrombosis with increasing D/R BSA ratio.ConclusionD/R size mismatch is associated with graft thrombosis after pancreas transplantation.

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Donor Predictors of Donor Pancreas Retrieval and Subsequent Solid Pancreas Transplantation in Australia and New Zealand from 2007 to 2016

Ling

Polkinghorne

Kanellis

2021

Transplantation Proceedings

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Risk Factors for Thrombosis in Simultaneous Pancreas-Kidney Transplants Performed Over Ten Years at Westmead Hospital

Cited by 3 publications

References 0 publications

Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review

Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review

Size‐mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study

Donor Predictors of Donor Pancreas Retrieval and Subsequent Solid Pancreas Transplantation in Australia and New Zealand from 2007 to 2016

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