title: How to avoid graft thrombosis requiring graftectomy: immediate posttransplant CT angiography in pancreas transplantation.
abstract: BACKGROUND
  Graft thrombosis immediately after surgery remains a problem for successful pancreas transplantation. The present study evaluated the efficacy of computed tomography (CT) angiography for monitoring of graft patency in the immediate postoperative period.
  
  
  METHODS
  The study involved 119 patients who underwent pancreas transplantation between July 1992 and December 2009 in a single center. The anticoagulation strategy was heparin during and after transplantation and then oral warfarin for 1 to 6 months. Graft thrombosis was monitored using color Doppler ultrasonography until July 2005 (group A) and, thereafter, using CT angiography (group B). We retrospectively analyzed the efficacy of diagnosis of graft thrombosis in two groups. Graft survival was assessed using Kaplan-Meier analysis.
  
  
  RESULTS
  Group A comprised 51 patients, and group B comprised 68 patients. Total vascular thrombosis was diagnosed in three (5.9%) group A and one (1.4%) group B patients, and partial venous thrombosis was diagnosed in 1 (2.0%) group A and 19 (31.6%) group B patients. Eighteen of the 19 grafts with partial thrombosis in group B were successfully treated using heparin-based anticoagulant therapy. There were no CT contrast media-related complications in group B. In group B, graft survival rates were the same for grafts with partial thrombosis and grafts without thrombosis.
  
  
  CONCLUSIONS
  CT angiography was safe and effective for evaluating graft patency after pancreas transplantation. Partial vascular thrombosis in the immediate posttransplantation period showed no effect on graft survival under intensive anticoagulation and monitoring by CT angiography.
authors.affiliation: Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Byun
authors.forename: Song-Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Duck-Jong
authors.initials: DJ
authors.lastname: Han
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging / Q000601:surgery*; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control*; D011184:Postoperative Period; D012189:Retrospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018608:Ultrasonography, Doppler; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin