Single-shot antithrombin in human pancreas-kidney transplantation: reduction of reperfusion pancreatitis and prevention of graft thrombosis*

Abstract

Summary Reperfusion pancreatitis and graft thrombosis often induce early graft loss in simultaneous pancreas–kidney (SPK) transplantation. Antithrombin (AT) is a coagulatory inhibitor with pleiotropic activities that reduces experimental ischemia/reperfusion injury. This study retrospectively analyses prophylactic high‐dose AT application in patients with first SPK. In an university transplantation center, 53 consecutive patients with SPK were studied without randomization. In one group, 3000 IU of AT was given intravenously before pancreatic reperfusion (AT, n = 24). Patients receiving standard therapy including postoperative AT supplementation (controls, n = 29) served as controls. Daily blood sampling was performed as a part of the clinical routine during four postoperative days. There were no differences in demographic and laboratory parameters [donor/recipient age, ischemia time, perfusion solution, body weight, mismatches] between both groups. Baseline creatinine values were lower in the control group versus AT group (P < 0.05). Coagulatory parameters and bleeding incidence were not influenced by AT, while incidence of graft thrombosis was reduced (control: 7/29; AT: 4/24; relative reduction of risk: −33%; P < 0.05). Single‐shot AT application during SPK modulated serum lipase activity on postoperative days 2 and 3, and minimized risk for graft thromboses without increasing perioperative bleeding. This new concept should deserve testing in a prospective clinical trial.

Pancreas graft thrombosis

“…Fertmann et al [33] evaluated intravenous antithrombin as prophylaxis for vascular thrombosis in 24 SPK transplants. Fertmann et al [33] evaluated intravenous antithrombin as prophylaxis for vascular thrombosis in 24 SPK transplants.…”

Prevention and Management of Graft Thrombosis in Pancreatic Transplant

“…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.…”

Revascularization of the gastroepiploic artery in pancreas transplant

“…As stated above, transient chemical pancreatitis from reperfusion injury is to be expected and is not harmful to the pancreas. The single shot antithrombin therapy advocated by some authors is interesting [11]. It has not led to bleeding despite the 3.8 days half-life of antithrombin and the absence of plasma antithrombin level monitoring as performed in our study [12].…”