Vascular complications following bladder drained, simultaneous pancreas-kidney transplantation: the University of Miami experience.
Vascular complications remain a significant nonimmunologic source of pancreas allograft loss. From February 1993 through January 1998, we performed 98 simultaneous pancreas-kidney transplantations (SPK) using pancreatic exocrine bladder drainage in patients with type 1 insulin-dependent diabetes mellitus and end-stage renal disease. They originally received quadruple immunosuppression, and since May 1997 triple immunosuppression protocol (tacrolimus, mycophenolate mofetil, and steroids). The patients' mean age was 37 years (range 24-53 years), including 50 women and 48 men with a mean follow-up of 42 months. The overall rate of vascular complications was 6% (5 patients). The vascular complications were as follows: late thrombosis of the Y with persistent pancreas allograft function (n = 1), rupture of a pseudoaneurysm of the superior mesenteric artery (PSMA) with an arteriovenous fistula (AVF) (n = 1), thrombosis of the splenic vein (SV) (n = 3), complete thrombosis of the superior mesenteric vein (SMV) and splenic vein (n = 1). The patient with PSMA underwent surgical correction of the AVF and PSMA with preservation of the allograft pancreas function. The other patient with late thrombosis of the Y-graft required no treatment. All 3 patients with SV thrombosis were systemically heparinized followed by oral anticoagulation. The patient with complete thrombosis required surgical thrombectomy of the SMV and SV followed by heparinization and oral anticoagulation. All 6 patients including the 4 with thrombosis had preservation of the pancreas function. Serial pancreas ultrasound showed resolution and improvement with recanalization of the splenic vein and superior mesenteric vein in those patients with thrombosis. We describe our vascular experience with salvage of the pancreatic allograft function. Surgery seems to be the best treatment option in the case of AVF or complete thrombosis of the allograft. Intravenous heparin followed by oral anticoagultion could be a conservative approach for SV thrombosis.
Ciancio
G
G
Department of Surgery, University of Miami School of Medicine, and the Miami Veterans Administration, Medical Center, Florida, USA. gciancio@mednet.med.miami.edu
Lo Monte
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A
Julian
J F
JF
Romano
M
M
Miller
J
J
Burke
G W
GW
D000328:Adult; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery; D000925:Anticoagulants / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D004359:Drug Therapy, Combination; D005260:Female; D005431:Florida; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D017538:Mesenteric Artery, Superior; D008642:Mesenteric Veins; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D011183:Postoperative Complications / Q000145:classification*; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*; D014652:Vascular Diseases / Q000145:classification* / Q000453:epidemiology / Q000209:etiology; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology
D000925:Anticoagulants; D007166:Immunosuppressive Agents