Pancreas Transplant Graft Evaluation Using the MIBI Scan— A Useful Tool

Sebastián, Anthony; Cuenca, Abigo; Li, S.-F.; Carlson, James R.; Lancaster, Michael; Cardello, J.; Nour, Bakr; Katz, Evan

doi:10.1016/s0041-1345(97)01251-7

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…This finding of thrombosis of the superior mesenteric and/or splenic vein was incidentally identified during routine CDU. Many techniques, including sonography [56], computed tomography [57], magnetic resonance [58], and Nuclear medicine scanning [59,60], have been used to evaluate for pancreatic graft thrombosis. We found CDU to be helpful in the diagnosis and assessment of incidental VT of the pancreatic allograft.…”

Section: Resultsmentioning

confidence: 99%

Partial venous thrombosis of the pancreatic allografts after simultaneous pancreas–kidney transplantation

Ciancio¹,

Cespedes

Olson

et al. 2000

Clinical Transplantation

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Despite new advances in transplantation, complete venous thrombosis (VT) of the pancreas after simultaneous pancreas kidney (SPK) transplantation usually results in graft loss. Data are limited regarding the outcome and treatment of partial VT of the pancreas allograft. From July 1994 to December 1999, 126 patients with IDDM/end-stage renal disease underwent SPK with systemic bladder drainage at the University of Miami. We retrospectively reviewed our experience regarding the outcome and treatment options of partial VT of the pancreas allografts. From July 1994 to April 1997, partial VT was not seen in the first 66 SPK patients induced with anti-CD3 rnAb and oral or intravenous (i.v.) tacrolimus (TAC) in the operating room. From May 1997 to June 1999, 14 (29%) out of 48 patients had VT. These cases were identified following the i.v. use of TAC with anti-IL-2R antibody-induction therapy (7/15) or without (7/33). Partial thrombosis of the splenic vein (PTSV) was documented in 10 patients, 2 had complete thrombosis of the splenic vein (CTSV), 1 had partial thrombosis of the superior mesenteric vein (PTSMV), and 1 patient had PTSV and PTSMV. These were identified incidentally during routine color Doppler ultrasonography (CDU). None of these SPK recipients demonstrates a change in clinical parameters. The first 8 patients were systemically heparinized, followed by oral anticoagulation, except 1 patient with CTSV. He progressed to complete thrombosis of the pancreas allograft and was treated with percutaneous thrombectomy and urokinase infusion, followed by heparinization and oral anticoagulation. One patient required exploration for bleeding. In an attempt to reduce the morbidity of heparinization, we treated the next 6 patients with PTSV with aspirin followed by serial CDU. All 14 patients had preservation of the endocrine and exocrine pancreatic functions. CDU showed resolution with recanalization of the thrombosed vein(s). From July 1999 to December 1999, 12 SPK recipients were administered TAC orally with or without induction therapy with anti-IL-2R antibody. So far, in this group, VT has not been identified. In summary, a total of 14 out of 126 patients (11%) had isolated VT with a mean follow-up of 36.4 months. Based on our experience, we suggest that extensive VT after pancreas transplantation, including splenic and superior mesenteric VT, be treated with heparin and subsequent oral anticoagulation for 3 months. For more limited, partial splenic VT, aspirin may be sufficient. Follow-up CDU is critical for a successful outcome. The i.v. use of TAC appears to be a risk factor for the increased incidence of VT. Currently, using IL-2rmAb as induction, TAC is started orally on postoperative days 3 or 4 and aspirin on postoperative day 2.

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Section: Resultsmentioning

confidence: 99%

Partial venous thrombosis of the pancreatic allografts after simultaneous pancreas–kidney transplantation

Ciancio¹,

Cespedes

Olson

et al. 2000

Clinical Transplantation

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Postoperative Management

Leone¹,

Christensen²,

Bhargava³

et al. 2004

Transplantation of the Pancreas

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A complication-free outcome after a pancreas transplant depends on detailed knowledge of both the recipient and donor. To minimize morbidity, postoperative care actually begins pre-and intraoperatively (see chapters 7 and 8). Transplant surgeons and physicians must anticipate the expected graft function and patient response to the operative procedure. Failure to do so will prolong the hospital stay and possibly compromise graft and patient survival. For example, if delayed kidney graft function is expected after a simultaneous pancreas and kidney (SPK) transplant pre-and intraoperative decisions can be made regarding fluid restriction, the need for early dialysis, and the choice of immunosuppressive agents. This chapter provides insight into the key elements necessary for the early management of pancreas transplants postoperatively, with emphasis on avoiding preventable complications.

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