Heparin infusion in simultaneous pancreas and kidney transplantation reduces graft thrombosis and improves graft survival.
Thrombosis of the pancreas after transplantation is the most common cause of relaparotomy and resultant graft loss. There is currently no standard protocol consistently proven to prevent thrombosis following transplantation. Our objective was to determine whether our protocol of post-operative low-dose intravenous (IV) heparin infusion would prevent graft thrombosis without additional complications in our patients.



A total of 66 simultaneous pancreas kidney (SPK) transplants were performed at our institution from 2004 to 2014. Patients were divided into 2 retrospective cohort groups. Group 1 patients received only acetylsalicylic acid (ASA) 81 mg/d started on post-operative day 1. Group 2 patients received IV heparin infusion beginning in the recovery room at a rate of 500 IU/h for the first 24 hours, reduced by 100 IU/h every day to stop on day 5, and then received ASA 81 mg/d afterward. Outcome and complication rates were compared between the two groups for 5 years post-transplant.



We observed a significant reduction in graft thrombosis and graft loss with (0/29) patients in the heparin group vs (7/33) 25.7% from the non-heparin (P<.01) with no differences in complication rates.



We present a heparin infusion protocol which may help prevent graft thrombosis and graft loss in SPK transplantation.
Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada.
Ghaleb
G
Aboalsamh
Division of Urology, Department of Surgery, Western University, London, Canada.
Patrick
P
Anderson
Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada.
Amira
A
Al-Abbassi
Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada.|Division of General Surgery, Department of Surgery, Western University, London, Canada.
Vivian
V
McAlister
Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada.|Division of Urology, Department of Surgery, Western University, London, Canada.
Patrick P
PP
Luke
Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada. alp.Sener@lhsc.on.ca.|Division of Urology, Department of Surgery, Western University, London, Canada. alp.Sener@lhsc.on.ca.|Department of Microbiology and Immunology, Western University, London, Canada. alp.Sener@lhsc.on.ca.
Alp
A
Sener
D000328:Adult; D002170:Canada / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006085:Graft Survival; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
D005343:Fibrinolytic Agents; D006493:Heparin
graft loss; heparin; pancreas transplantation; thromboprophylaxis; thrombosis