Treatment and outcome of pancreatic venous graft thrombosis after kidney–pancreas transplantation

• DOI: 10.1046/j.0007-1323.2001.02016.x
• Publication Date: 2003-03-11T07:27:47Z
• Authors: R Gilabert; L Fernández-Cruz; M I Real; M J Ricart; E Astudillo; X Montaña
• Keywords: Adult; Male; Postoperative Care; Graft Occlusion, Vascular; Kidney Transplantation; 3. Good health; 03 medical and health sciences; Diabetes Mellitus, Type 1; Pancreatectomy; Treatment Outcome; 0302 clinical medicine; Humans; Female; Thrombolytic Therapy; Pancreas Transplantation; Thrombectomy; Ultrasonography

AbstractBackgroundPancreas venous graft thrombosis after transplantation is the main non-immunological cause of graft failure and usually results in pancreatectomy. Duplex Doppler ultrasonography is the primary imaging technique for monitoring vascular patency after pancreas transplantation. This study reports the results of rescue treatments for pancreas graft thrombosis after simultaneous pancreas–kidney transplantation.MethodsOne hundred and ninety-six patients with insulin-dependent diabetes mellitus received a simultaneous pancreas–kidney transplantation. Venous graft thrombosis was diagnosed in 25 of these patients based on Doppler ultrasonographic findings.ResultsTotal venous graft thrombosis was diagnosed in 20 symptomatic patients, of whom 14 required graft pancreatectomy. Surgical thrombectomy was attempted in six patients with preserved arterial supply and was successful in four. Partial venous graft thrombosis was diagnosed in five asymptomatic patients; one also had partial splenic artery thrombosis. Rescue graft procedures included systemic anticoagulation (one patient), arterial thrombolysis (one) and venous thrombolysis and/or mechanical venous thrombectomy (four episodes in three patients). Graft rescue was achieved in three patients treated by venous thrombolysis/thrombectomy.ConclusionDoppler ultrasonography allows the appropriate selection of rescue treatment based on the findings of total or partial thrombosis.