Simultaneous pancreas–kidney transplantation: to anticoagulate or not? Is that a question?

Vaidya, Anil; Muthusamy, Anand; Hadjianastassiou, Vassilis G.; Roy, Debabrata; Elker, Doruk; Moustafellos, P; Muktadir, Abdul; Sinha, Sanjay; Friend, Peter J.

doi:10.1111/j.1399-0012.2007.00689.x

Cited by 43 publications

(41 citation statements)

References 11 publications

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“…A more valid debate that has been suggested is whether all patients require the same anticoagulation protocol. 31 The continued use of anticoagulation postoperatively is an undoubtedly contentious issue; difficulties will almost certainly arise in balancing thrombosis rates with bleeding rates.…”

Section: Pharmacological Prophylaxismentioning

confidence: 99%

“…Noncomplex thromboses (ie, partial or those isolated to the splenic vein) can be managed with systemic anticoagulation and the specific regimens vary as widely as the prophylaxis regimens discussed above. 8,9,31 Surgical salvage of thrombosed grafts was initially reported with thrombectomy being the specific surgical intervention. 8,35,36 This has been shown to be effective even against complete venous thrombosis by Ciancio and associates in 2000.…”

Section: Pharmacological Prophylaxismentioning

confidence: 99%

“…29 Another, by Vaidya and associates, uses thromboelastography to successfully predict individual antithrombotic requirements; this approach led to a thrombosis rate of 0% in their study. 31 More novel drugs such as recombinant antithrombin III, 33 and dabigatran, a direct thrombin inhibitor, may play a role in the future. Financial reasons, however, will limit their immediate introduction to this arena.…”

Section: Pharmacological Prophylaxismentioning

confidence: 99%

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Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Patel¹,

Hakim²

2012

Exp Clin Transplant

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Pancreatic transplant effectively cures type 1 diabetes mellitus and maintains consistent longterm euglycemia. However, technical failure, and in particular graft thrombosis, accounts for the vast majority of transplants lost in the early postoperative period. The pancreas' inherently low microvascular flow state makes it vulnerable to vascular complications, as does the hypercoagulable blood of diabetic patients. Ultimately, the phenomenon is most definitely multifactorial. Prevention, as opposed to treatment, is key and should focus on reducing these multiple risk factors. This will involve tactical donor selection, optimal surgical technique and some form of anticoagulation. Close monitoring and early intervention will be crucial when treating thrombosis once preventative methods have failed. This may be achieved by further anticoagulation, graft salvage, or pancreatectomy with retransplant. This article will explore the multiple factors contributing to graft thrombus formation and the ways in which they may be addressed to firstly prevent, or more likely, reduce thrombosis. Secondly, we will consider the management strategies which can be implemented once thrombosis has occurred.

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Section: Pharmacological Prophylaxismentioning

confidence: 99%

Section: Pharmacological Prophylaxismentioning

confidence: 99%

Section: Pharmacological Prophylaxismentioning

confidence: 99%

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Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Patel¹,

Hakim²

2012

Exp Clin Transplant

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“…Perioperative anticoagulation is an important strategy to prevent this complication but may result in increased rate of reexploration for bleeding as was seen in our patient. Monitoring by thromboelastography (TEG) has been shown to be helpful in assessing coagulation status and can reduce the increased risk of bleeding after pancreas transplant [16].…”

Section: Discussionmentioning

confidence: 99%

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

et al. 2016

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Pancreatic transplantation is currently the only effective cure for Type 1 diabetes mellitus. It allows long-term glycemic control without exogenous insulin and amelioration of secondary diabetic complications. In India, pancreas transplant has not yet established with only a single successful transplant reported so far in the literature. We report a 24-year-old Type 1 diabetic patient with renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 15, he had leak from the graft duodenal stump for which a tube duodenostomy and proximal diversion enterostomy was done. He had a high output pancreatic fistula following the procedure which was managed conservatively. The tube duodenostomy was removed at three and half months and enterostomy closure with restoration of bowel continuity was done at 6 months. After a follow up of 7 months, patient is doing well with a serum creatinine of 0.8 mg/dl and normal blood sugars, not requiring any exogenous insulin or oral hypoglycemic drugs. Managing patients with graft duodenal complications after pancreas transplant is challenging. Tube duodenostomy is a safe option in management of duodenal leak, although can lead to a persistent pancreatic fistula. A proximal diversion enterostomy allows early oral feeding and avoids the cost as well as the long term complications associated with parenteral nutrition.

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“…They were no graft losses because of a thrombosis in a series of 74 pancreatic transplants with anticoagulation guided by thromboelastography, 18 which measures coagulation time, quality of clot, and time to fibrinolysis.…”

Section: Discussionmentioning

confidence: 99%

Successful Endovascular Salvage of a Pancreatic Graft After a Venous Thrombosis: Case Report and Literature Review

Asher

Talbot²,

Manas³

et al. 2013

Exp Clin Transplant

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Simultaneous kidney and pancreatic transplant is the criterion standard for treatment of end-stage renal failure because of diabetic nephropathy. Venous thrombosis occurs in approximately 5% of pancreatic transplants, and it is notoriously difficult to treat, forming the most common nonimmunologic cause of graft loss. We report a case of early detection of pancreatic graft venous thrombosis by measuring urinary amylase, resulting in the successful endovascular salvage of the pancreatic graft.

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Simultaneous pancreas–kidney transplantation: to anticoagulate or not? Is that a question?

Cited by 43 publications

References 11 publications

Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

Successful Endovascular Salvage of a Pancreatic Graft After a Venous Thrombosis: Case Report and Literature Review

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