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Zorkany, Khaled El; Bridson, Julie-Michelle; Sharma, Ajay; Halawa, Ahmed

doi:10.6002/ect.2016.0060

Cited by 13 publications

(14 citation statements)

References 60 publications

(110 reference statements)

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“…As evidenced from the study none of the kidneys in the TEG group were lost to thrombosis. Transplant renal vein thrombosis occurs early after the transplantation with a reported incidence of 0.1%-4.2% and diabetes in the recipient is one among the other risk factors for graft thrombosis[ 22 , 23 ]. TEG-directed anticoagulation in diabetic patients needing kidney transplantation is another potential area for application.…”

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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Section: Discussionmentioning

confidence: 99%

Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

Gopal¹,

Dor²,

Crane³

et al. 2020

WJT

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“…When US methods are inconclusive and vascular pathology of the transplanted kidney is suspected, CT angiography or MRI are the imaging modalities of choice. Thrombosis of the transplanted renal vein (TTRV) is also a rare event: it usually occurs early after surgery with a reported prevalence of 0.1% to 4.2% [ 34 ]. It can be complete, in which case it involves loss of the graft, or partial loss.…”

Section: Ceus Role For Transplant Kidney Complicationsmentioning

confidence: 99%

Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications

et al. 2022

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Renal transplantation (RT) is the treatment of choice for end-stage renal disease, significantly improving patients’ survival and quality of life. However, approximately 3–23% of patients encounter post-operative complications, and radiology plays a major role for their early detection and treatment or follow-up planning. CT and MRI are excellent imaging modalities to evaluate renal transplant post-operative course; nevertheless, they are both associated with a high cost and low accessibility, as well as some contraindications, making them not feasible for all patients. In particular, gadolinium-based contrast can lead to the rare condition of nephrogenic systemic fibrosis, and iodine-based contrast can lead to contrast-induced nephropathy (CIN). CT also exposes the patients who may require multiple examinations to ionizing radiation. Therefore, considering the overall advantages and disadvantages, contrast-enhanced ultrasound (CEUS) is presently considered an effective first-line imaging modality for post-operative early and long-term follow-up in RT, reducing the need for biopsies and providing adequate guidance for drainage procedures. Hence, this paper aims to review the updated knowledge on CEUS compared with CT and MRI for the evaluation of RT renal transplant complications; advantages, limitations, and possible recommendations are provided.

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“…On grayscale US, the early phase of disease is characterized by enlargement of the graft and hypoechoic appearance of the cortex[ 30 ]. On Doppler examination, the thrombus can be difficult to visualize if venous anastomosis is located deeply in the pelvis.…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…On Doppler examination, the thrombus can be difficult to visualize if venous anastomosis is located deeply in the pelvis. Indirect signs rising the suspicion of TRVT are reversed arterial diastolic flow, spike-like systolic component, and elevated resistive indexes[ 30 ]. However, while those findings have good sensitivity, they lack specificity as they occur also in other complications, including allograft torsion, severe rejection, and ATN[ 31 ].…”

Section: Clinical Applicationsmentioning

confidence: 99%

Role for contrast-enhanced ultrasound in assessing complications after kidney transplant

Como¹,

Re²,

Adani³

et al. 2020

WJR

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Kidney transplantation (KT) is an effective treatment for end-stage renal disease. Despite their rate has reduced over time, post-transplant complications still represent a major clinical problem because of the associated risk of graft failure and loss. Thus, post-KT complications should be diagnosed and treated promptly. Imaging plays a pivotal role in this setting. Grayscale ultrasound (US) with color Doppler analysis is the first-line imaging modality for assessing complications, although many findings lack specificity. When performed by experienced operators, contrast-enhanced US (CEUS) has been advocated as a safe and fast tool to improve the accuracy of US. Also, when performing CEUS there is potentially no need for further imaging, such as contrast-enhanced computed tomography or magnetic resonance imaging, which are often contraindicated in recipients with impaired renal function. This technique is also portable to patients’ bedside, thus having the potential of maximizing the cost-effectiveness of the whole diagnostic process. Finally, the use of blood-pool contrast agents allows translating information on graft microvasculature into time-intensity curves, and in turn quantitative perfusion indexes. Quantitative analysis is under evaluation as a tool to diagnose rejection or other causes of graft dysfunction. In this paper, we review and illustrate the indications to CEUS in the post-KT setting, as well as the main CEUS findings that can help establishing the diagnosis and planning the most adequate treatment.

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Untitled

Cited by 13 publications

References 60 publications

Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications

Role for contrast-enhanced ultrasound in assessing complications after kidney transplant

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