Pancreas graft thrombosis: is there a role for trypsin.
OBJECTIVE
Thrombosis of the pancreas graft is the main cause of early graft loss in pancreas transplantation. We investigated whether hypercoagulability develops locally in the pancreas and contributes to thrombosis formation because of ischemia or reperfusion injury. It was further hypothesized that this might be induced by excessive intravascular trypsin activity.


METHODS
Ten Patients undergoing pancreas transplantation were studied. In addition to the standard operation a 14 French catheter was inserted in the distal part of the splenic vein of the pancreas graft. After reperfusion blood samples were drawn simultaneously from the splenic vein of the pancreas graft (local samples) and the radial artery (systemic samples) at 0,1,2,5,10,30, and 60 minutes after reperfusion.


RESULTS
After reperfusion a progressive hypercoagulability developed locally in the pancreas as seen by an increase of thrombin-antithrombin complexes and only a transient increase of plasmin-antiplasmin complexes. In addition antithrombin 3 and protein c decreased systemically. The alterations seem not to be triggered by trypsin because trypsin activity locally remained low despite trypsinogen release and activation as assessed by trypsinogen activation peptides.


CONCLUSIONS
Local hypercoagulability might contribute to the development of graft thrombosis, however, the mechanism seems not to be related to ectopic trypsin activation.
Benz
S
S
Department of Visceral Surgery, University of Freiburg, Germany. stefanrolfbenz@web.de
Busing
M
M
Kruger
B
B
Mayer
J M
JM
Obermaier
R
R
Keck
T
T
Pfeffer
F
F
Hopt
U T
UT
D000991:Antithrombins / Q000378:metabolism; D001777:Blood Coagulation; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D005260:Female; D005341:Fibrinolysin / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D008297:Male; D009842:Oligopeptides / Q000378:metabolism; D010179:Pancreas / Q000098:blood supply / Q000378:metabolism; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D011486:Protein C / Q000378:metabolism; D013917:Thrombin / Q000378:metabolism; D013927:Thrombosis / Q000097:blood / Q000209:etiology*; D013997:Time Factors; D014357:Trypsin / Q000097:blood / Q000378:metabolism; D014362:Trypsinogen / Q000378:metabolism; D000979:alpha-2-Antiplasmin / Q000378:metabolism
D000991:Antithrombins; D009842:Oligopeptides; D011486:Protein C; D000979:alpha-2-Antiplasmin; C080396:trypsinogen activation peptide; D014362:Trypsinogen; D014357:Trypsin; D013917:Thrombin; D005341:Fibrinolysin