Treatment and outcome of pancreatic venous graft thrombosis after kidney--pancreas transplantation.
BACKGROUND
Pancreas 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.


METHODS
One 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.


RESULTS
Total 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.


CONCLUSIONS
Doppler ultrasonography allows the appropriate selection of rescue treatment based on the findings of total or partial thrombosis.
Gilabert
R
R
Imaging Diagnosis Center, Department of Surgery and Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Fernández-Cruz
L
L
Real
M I
MI
Ricart
M J
MJ
Astudillo
E
E
Montaña
X
X
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010180:Pancreatectomy / Q000379:methods; D011182:Postoperative Care; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography