Pancreas graft thrombosis

Farney, Alan C.; Rogers, Jeffrey; Stratta, Robert J.

doi:10.1097/mot.0b013e32834ee717

Cited by 82 publications

(29 citation statements)

References 36 publications

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“…Pancreatic allograft thrombosis (PAT) is a potentially catastrophic complication and remains one of the leading causes of nonimmunologic allograft loss 1, 2. The incidence reported in the literature ranges from 1% to 40% and accounts for 29% of grafts lost within the first 6 months after transplantation 3, 4.…”

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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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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“…With the rising organ scarcity and shifting donor demographics, the pancreas transplant community has obviously expanded the donor acceptance criteria. This together with increasing DCD donation in many countries can potentially increase the incidence of pancreas graft thrombosis[ 19 - 21 ]. TEG can be a promising tool that can aid to push the boundary more effectively thereby translating into more successful clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

Gopal¹,

Dor²,

Crane³

et al. 2020

WJT

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BACKGROUND Despite technical refinements, early pancreas graft loss due to thrombosis continues to occur. Conventional coagulation tests (CCT) do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated. Thromboelastogram (TEG) is an in-vitro diagnostic test which is used in liver transplantation, and in various intensive care settings to guide anticoagulation. TEG is better than CCT because it is dynamic and provides a global hemostatic profile including fibrinolysis. AIM To compare the outcomes between TEG and CCT (prothrombin time, activated partial thromboplastin time and international normalized ratio) directed anticoagulation in simultaneous pancreas and kidney (SPK) transplant recipients. METHODS A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients, who were matched for donor age and graft type (donors after brainstem death and donors after circulatory death). Anticoagulation consisted of intravenous (IV) heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG results. Graft loss due to thrombosis, anticoagulation related bleeding, radiological incidence of partial thrombi in the pancreas graft, thrombus resolution rate after anticoagulation dose escalation, length of the hospital stays and, 1-year pancreas and kidney graft survival between the two groups were compared. RESULTS Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients (ratio of 1: 3) who were anticoagulated based on CCT. No graft losses occurred in the TEG group, whereas 11 grafts (7 pancreases and 4 kidneys) were lost due to thrombosis in the CCT group ( P = 0.06, Fisher’s exact test). The overall incidence of anticoagulation related bleeding (hematoma/ gastrointestinal bleeding/ hematuria/ nose bleeding/ re-exploration for bleeding/ post-operative blood transfusion) was 17.65% in the TEG group and 45.10% in the CCT group ( P = 0.05, Fisher’s exact test). The incidence of radiologically confirmed partial thrombus in pancreas allograft was 41.18% in the TEG and 25.50% in the CCT group ( P = 0.23, Fisher’s exact test). All recipients with partial thrombi detected in computed tomography (CT) scan had an anticoagulation dose escalation. The thrombus resolution rates in subsequent scan were 85.71% and 63.64% in the TEG group vs the CCT group ( P = 0.59, Fisher’s exact test). The TEG group had reduced blood product usage {10 packed red blood cell (PRBC) and 2 fresh frozen plasma (FFP)} compared to the CCT group (71 PRBC/ 10 FFP/ 2 cryoprecipitate and 2 platelets). The proportion of patients requiring transfusion in the TEG group was 17.65% ...

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“…Graft thrombosis is the most important technical cause of whole organ pancreatic allograft loss. Pancreas retrieval and surgical technique is a significant etiologic factor in the incidence of graft thrombosis [101][102][103][104]. Graft pancreatitis, which in itself is a significant risk factor for graft thrombosis, is another potentially catastrophic complication associated with morbidity and graft loss that is partly attributable to retrieval technique [100].…”

Section: The Impact Of Procurement Practices and Techniquesmentioning

confidence: 99%

Pancreas Retrieval for Whole Organ and Islet Cell Transplantation

Hawthorne¹,

Hameed²,

Pleass³

2018

Organ Donation and Transplantation - Current Status and Future Challenges

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For more than five decades, we have been refining advances in pancreas whole organ and islet cell transplantation as clinical therapies to treat the ever-increasing number of patients suffering from type-1-diabetes. Research and clinical practice have contributed to making both whole organ and cellular transplantation viable therapeutic options for a broader range of patients. Furthermore, both forms of clinical transplantation results have progressively improved, due to the ongoing refinement of organ donation and its various technical processes, combined with the evolution of immunosuppression and patient care now offering excellent long-term treatment for both type-1-diabetes and concomitant renal failure. This chapter provides an overview on how this has been undertaken and achieved over decades to ultimately provide outstanding outcomes on par with other organ transplantation results. Briefly, we cover the history of pancreas retrieval procedures, the importance of donor selection, the intricate processes of the organ donor operation, preservation of the pancreas, and the ideal ways to best improve outcomes for transplantation. Improving and providing the optimal donor and preservation conditions underpinning the success of subsequent whole pancreas or islet transplantation as a safe, effective, and feasible therapeutic option for an increasing number of patients suffering from type-1-diabetes.

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Pancreas graft thrombosis

Abstract: Thrombectomy, either surgical or percutaneous, may salvage the pancreas graft if performed early after the occurrence of thrombosis.

Cited by 82 publications

References 36 publications

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

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

Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

Pancreas Retrieval for Whole Organ and Islet Cell Transplantation

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