title: Preservation of pancreas graft function after complete venous thrombosis:  report of four cases treated conservatively.
abstract: BACKGROUND
  Pancreas graft thrombosis is the most common cause of technical graft failure, with an incidence of up to 20% is some series. In most instances, vascular thrombosis of the graft will require immediate removal to avoid further abdominal complications. We present a total of four cases of complete venous thrombosis with preservation of function that were managed conservatively, resulting in long-term graft function.
  
  
  METHODS
  Retrospective analysis of our case series over 10 years was carried out, obtaining patients with complete graft thrombosis by Doppler ultrasound. We included in the study only those patients who remained asymptomatic with preserved graft function. The clinical status of the patients, radiological findings, and therapeutic approach are evaluated. Patient and graft outcomes are analyzed.
  
  
  RESULTS
  Retrospective evaluation of 227 transplants, a total of four patients were found to have complete thrombosis of the graft, remaining asymptomatic and preserving function without complications. Graft thrombosis was found on routine Doppler ultrasound evaluation of the transplanted organs at a median time of 19 days (range, 11-28 days), angiographic confirmation was obtained in all cases. The clinical condition and the presence of collateral flow allowed for conservative treatment. Median hospital stay was 29 days (range, 16-38 days), with a median follow-up of 106 months (range, 24-110 months), all patients are alive with a functioning graft.
  
  
  CONCLUSIONS
  In rare instances with complete thrombosis of the pancreas transplant in absence of clinical manifestations, the grafts can be closely monitored and treated with systemic anticoagulation, allowing long-term patient and graft survival.
authors.affiliation: Department of Hepatobiliopancreatic Surgery and Transplantation, Hospital Clinic, Barcelona, Spain. raqgar@hotmail.com
authors.forename: Raquel
authors.initials: R
authors.lastname: Garcia-Roca
authors.forename: Julia
authors.initials: J
authors.lastname: Samamé
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Garcia-Criado
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Real
authors.forename: Rosa
authors.initials: R
authors.lastname: Gilabert
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Ricart
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000502:physiology; D011169:Portal Vein; D012189:Retrospective Studies; D013162:Splenic Vein; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*
chemical_list: D000925:Anticoagulants