Early Reexploration for Suspected Thrombosis After Pancreas Transplantation

Fridell, Jonathan A.; Mangus, Richard S.; Mull, Aaron B.; Taber, Tim E.; Sanders, Carrie E.; Slisher, Robert C.; Goble, Michelle L.; Powelson, John A.

doi:10.1097/tp.0b013e3182106069

Cited by 45 publications

(47 citation statements)

References 36 publications

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“…It is likely that only those pancreata with mild damage were implanted, introducing bias into the analysis. Furthermore, the majority of injured organs had a shortened portal vein (defined as less than 10 mm length), and some surgeons believe that this reduces the rate of venous thrombosis (20,21). In any case, the use of a portal vein extension graft does not appear to increase the rate of graft loss (22).…”

Section: Discussionmentioning

confidence: 99%

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Ausania

Drage

Manas

et al. 2015

American Journal of Transplantation

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Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p ¼ 0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p ¼ 0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p ¼ 0.04) and in those with parenchymal damage (p ¼ 0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.

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Section: Discussionmentioning

confidence: 99%

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Ausania

Drage

Manas

et al. 2015

American Journal of Transplantation

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“…Although there is no consensus on the classification or reporting of PAT, it is generally categorized as either complete or partial 16. Complete occlusion usually results in graft loss, unless thrombectomy or thrombolysis are undertaken soon after onset 17, 18, 19, 20. Conversely, there is some evidence to suggest a higher likelihood of pancreas allograft salvage with anticoagulation alone after partial thrombosis, although other interventions are occasionally required 21, 22.…”

Section: Introductionmentioning

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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“…Recently Fridell et al [5] reported 343 pancreas transplants, in which early urgent re-exploration for suspected graft pancreas thrombosis was indicated based on the presence of an unexplained hyperglycemia or the failure to achieve euglycemia 1 week after grafting. This approach resulted in 35 early surgical re-explorations with the graft being compromised in 20 (57 %) cases, 10 of which involved venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of randomization and a control group treated with anticoagulation prevents to assess in what number of these patients, particularly those with thrombus 30-60 % in length, anticoagulation alone would have been effective. The current literature dealing with the available salvage strategies is retrospective without comparing the different treatment options [4][5][6][7][8][9][10][11][12]. The low incidence of PVGT makes it difficult to compare the treatment options in a prospective randomized study in a single institution.…”

Section: Discussionmentioning

confidence: 99%

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Pancreas Transplants Venous Graft Thrombosis: Endovascular Thrombolysis for Graft Rescue

Barrufet

Burrel

García-Criado

et al. 2013

Cardiovasc Intervent Radiol

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Purpose To retrospectively assess the efficacy and safety of percutaneous endovascular treatment in patients with pancreas venous graft thrombosis (PVGT). Between 2001 and 2009, 206 pancreas transplants were performed at our institution. A retrospective review of pancreas graft recipients who underwent endovascular therapy for PVGT was performed. The study group included 17 patients (10 men, 7 women; mean age 38 years) with PVGT (\60 % [9 patients]; 30-60 % [8 patients]) 6.6 ± 5.7 days after grafting. The angiographic studies, type of endovascular procedure, endovascular procedural and postprocedural effectiveness, and patient and graft outcomes were assessed. Results In 16 of 17 cases (94 %), significant (87.5 %) or partial (12.5 %) lysis of thrombi was achieved. One patient had external compression of the portal vein due to a hematoma, which hindered mechanical removal of the thrombi. This patient required graft pancreatectomy for extensive areas of parenchymal necrosis 2 days after the endovascular procedure. No complications related to endovascular treatment were observed. Postprocedural bleeding episodes related to anticoagulation were observed in five patients. Patient and pancreas graft survival rates at 12 months were 94 and 76 %, respectively. Conclusion Catheter-directed thrombectomy is an effective treatment for patients with PVGT. Percutaneous thrombectomy, followed by anticoagulation, appears to be an effective therapy to remove the thrombus and is associated with a low complication rate. Materials and Methods

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Early Reexploration for Suspected Thrombosis After Pancreas Transplantation

Abstract: Reexploration for suspected graft thrombosis after pancreas transplantation resulted in a negative laparotomy rate of 43%, but permitted graft salvage in 45% of compromised grafts.

Cited by 45 publications

References 36 publications

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

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

Pancreas Transplants Venous Graft Thrombosis: Endovascular Thrombolysis for Graft Rescue

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