Vascular Complications of Pancreas Transplantation

Spiros, Delis; Christos, Dervenis; Bramis, John; Burke, George W.; Miller, Joshua; Ciancio, Gaetano

doi:10.1097/00006676-200405000-00010

Cited by 46 publications

(13 citation statements)

References 39 publications

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“…managed partial venous thrombosis (n = 10) with aspirin alone and showed no progression of thrombosis. They reported recanalization of the thrombosed veins on follow‐up imaging and, overall, there was no effect on graft survival 32. Our retrospective review of images at 3 months and subsequently showed that majority of patients who were not anticoagulated for thrombosis had a reduction in grade of thrombosis to no thrombosis or lower grade thrombosis.…”

Section: Discussionmentioning

confidence: 72%

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: Discussionmentioning

confidence: 72%

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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“…Las complicaciones más frecuentes que conllevan al fracaso del injerto son de causa inmunológica, como el rechazo agudo (7 a 25%) y crónico (2 a 33%), y de causa técnica (trombosis, pancreatitis, sangrado, dehiscencia de anastomosis duodenal, pseudoaneurismas, fístula pancreática), actualmente en menos del 8% (27,(43)(44)(45)(46)(47) . Las complicaciones más frecuentes son la trombosis y el rechazo agudo, siendo las dos causas principales de pérdida del injerto (48) .…”

Section: Discussionunclassified

“…En este primer caso, se produjeron, como hemos documentado, complicaciones que fueron de impacto leve (pancreatitis leve, fístula controlada y autolimitada, y trombosis de la arteria esplénica, compensada por el suministro de colaterales de la arteria mesentérica superior), no requiriendo de reoperaciones ni readmisiones hospitalarias. El páncreas es uno de los órganos más propensos a la trombosis después del trasplante, debido al bajo flujo sanguíneo a nivel parenquimal, el cual disminuye aún más al extirpar el bazo, y al invariable edema del órgano por injuria por isquemia-reperfusión y manipulación durante las fases de extracción y trabajo de banco (46,47,51) . La trombosis es principalmente venosa, se produce precozmente en los primeros días post-trasplante, y habitualmente obliga a la extirpación del injerto.…”

Section: Discussionunclassified

Trasplante simultáneo de páncreas y riñón: reporte del primer caso realizado en el Perú

et al. 2011

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El trasplante simultáneo de páncreas y riñón es la opción terapéutica ideal para pacientes con diabetes mellitus tipo 1 con insuficiencia renal crónica. Permite recuperar la insulino-independencia y evita la necesidad de diálisis, mejorando notablemente la calidad de vida. Así mismo, la restitución de la euglicemia logra que las complicaciones tardías de la diabetes no progresen e incluso regresionen, prolongando la supervivencia global de estos pacientes. Estos beneficios superan a los riesgos de la cirugía y de la inmunosupresión inherentes al trasplante. A nivel mundial, desde 1966, en que se llevó a cabo el primer trasplante de páncreas en Minnesota (Estados Unidos), se han registrado más de 20 000 trasplantes de páncreas, con resultados cada vez mejores gracias al refinamiento en las técnicas quirúrgicas y a los nuevos esquemas de inmunosupresión. En el presente caso clínico, se reporta y describe la realización del primer trasplante simultáneo de páncreas y riñón en el Perú.

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“…The ramifications of venous thrombosis are more problematic in the pancreas transplant patient given the risk of developing post‐thrombotic syndrome in addition to potential allograft dysfunction or loss. Treatment of this problem in this population continues to consist of standard anticoagulation and/or operative thrombectomy, although the latter can be associated with significant peri‐operative risks (11–13). Despite its success in non‐transplant patients, little has been reported on the efficacy of catheter‐directed therapy for venous thromboses in pancreas transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Catheter‐directed therapy for DVT after pancreas transplantation

Mahanty

Posselt

Lipshutz

et al. 2007

Clinical Transplantation

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Vascular Complications of Pancreas Transplantation

Abstract: Early diagnosis of vascular complications after pancreas transplantation is of paramount importance for the appropriate treatment with organ salvage. Based on our experience, we suggest that VT can be effectively treated with anticoagulation. Aspirin is sufficient for PSVT.

Cited by 46 publications

References 39 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

Trasplante simultáneo de páncreas y riñón: reporte del primer caso realizado en el Perú

Catheter‐directed therapy for DVT after pancreas transplantation

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