1
|
Tu JP, Shi XF, Wang H, Zhao J, Wang X, Mo CB, Song WL. A study on the prevention of thrombosis after simultaneous pancreas-kidney transplantation. Technol Health Care 2024:THC232037. [PMID: 39058462 DOI: 10.3233/thc-232037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Renal failure is one of the most common chronic complications of diabetes. Simultaneous pancreas-kidney transplantation (SPK) is considered the preferred treatment for individuals with diabetes and chronic renal failure. This procedure has demonstrated efficacy in enhancing the quality of life for patients and minimizing the complications associated with diabetes. OBJECTIVE In this study, we analyzed the incidence and safety of complications in different thrombosis prevention techniques post simultaneous pancreas-kidney transplantation (SPK). METHODS Patients who underwent SPK between January 2019 and December 2022 were selectively categorized into two groups: the heparin group and the non-heparin group depending on the utilization of low molecular weight heparin. The occurrence of complications and clinical outcomes were subsequently calculated in each group. RESULTS In this study, we included a total of 58 recipients who underwent SPK, with 36 in the heparin group and 22 in the non-heparin group. Among the 58 participants, there were 3 cases of pancreatic thrombosis complications, with 2 cases (5.6%) in the heparin group and 1 case (4.6%) in the non-heparin group, and the differences were not statistically significant (P> 0.05). Regarding gastrointestinal bleeding, there were 17 cases out of the total 58 patients, with 14 cases (38.9%) in the heparin group and 3 cases (13.6%) in the non-heparin group, and the difference was statistically significant (P< 0.05). CONCLUSION After surgery, the use of low molecular weight heparin anticoagulation may increase the likelihood of experiencing gastrointestinal bleeding. Prior to the surgery, a comprehensive evaluation of the coagulation status and medical history of the patient should be performed, enabling stratification of risks involved. Based on this assessment, either low-molecular-weight heparin or aspirin should be selected as a preventive measure against thrombosis.
Collapse
Affiliation(s)
- Jin-Peng Tu
- Organ Transplant Department, Tianjin First Central Hospital, Tianjin, China
| | - Xiao-Feng Shi
- Organ Transplant Department, Tianjin First Central Hospital, Tianjin, China
| | - Hui Wang
- Organ Transplant Department, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhao
- Organ Transplant Department, Tianjin First Central Hospital, Tianjin, China
| | - Xin Wang
- Organ Transplant Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chun-Bai Mo
- Organ Transplant Department, Tianjin First Central Hospital, Tianjin, China
| | - Wen-Li Song
- Organ Transplant Department, Tianjin First Central Hospital, Tianjin, China
| |
Collapse
|
2
|
Kaku K, Okabe Y, Kubo S, Sato Y, Mei T, Noguchi H, Tomimaru Y, Ito T, Kenmochi T, Nakamura M. Size-mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study. Clin Transplant 2023; 37:e15090. [PMID: 37534624 DOI: 10.1111/ctr.15090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Donor-recipient (D/R) size mismatch has been evaluated for a number of organs but not for pancreas transplantation. METHODS We retrospectively evaluated 438 patients who had undergone pancreas transplantation. The D/R body surface area (BSA) ratio was calculated, and the relationship between the ratio and graft prognosis was evaluated. We divided the patients into two groups and evaluated graft survival. The incidence of pancreas graft thrombosis resulting in graft failure within 14 days and 1-year graft survival were compared using Kaplan-Meier curves, and the prognostic factors associated with graft thrombosis were identified by univariate and multivariate analyses. RESULTS The mean/median donor and recipient BSAs were 1.63 m2 /1.65 m2 , and 1.57 m2 /1.55 m2 , respectively; the mean and median D/R BSAs were both 1.05. The receiver operating characteristic curve cutoff for the D/R BSA ratio was 1.09, and significant differences were identified between patients with ratios of ≥1.09 (high group) versus <1.09 (low group). The incidence of graft thrombosis resulting in pancreas graft failure within 14 days was significantly higher in the high group than in the low group (p < .01). One-year overall and death-censored pancreas graft survival were significantly higher in the low group than in the high group (p < .01). Multivariate analysis identified recipient height, donor BSA, and donor hemoglobin A1c as significant independent factors for graft thrombosis. Cubic spline curve analysis indicated an increased risk of graft thrombosis with increasing D/R BSA ratio. CONCLUSION D/R size mismatch is associated with graft thrombosis after pancreas transplantation.
Collapse
Affiliation(s)
- Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinsuke Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Mei
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
- The Japan Pancreas Transplant Registry, Japan Society for Pancreas and Islet Transplantation, Suita, Japan
| | - Toshinori Ito
- The Japan Pancreas Transplant Registry, Japan Society for Pancreas and Islet Transplantation, Suita, Japan
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Takashi Kenmochi
- The Japan Pancreas Transplant Registry, Japan Society for Pancreas and Islet Transplantation, Suita, Japan
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
3
|
Effective Technique for Pancreas Transplantation by Iliac Vascular Transposition, Without Heparin-Based Anticoagulation Therapy. World J Surg 2021; 46:215-222. [PMID: 34705093 DOI: 10.1007/s00268-021-06232-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND To evaluate patients undergoing a new procedure, iliac vascular transposition, in pancreas transplantation regarding the risk of thrombosis and graft survival without heparin-based anticoagulation therapy. METHODS Iliac vascular transposition (IVT) involves changing the positions of the external iliac artery and vein relative to each other. In this study, this technique was evaluated in patients undergoing the procedure compared with patients not undergoing the procedure (iliac vascular parallel (IVP) group). RESULTS No patients received prophylactic heparin therapy. Two patients in the IVP group (n = 26) developed complete thrombosis and six developed partial thrombosis, compared with no patients with complete thrombosis and one with partial thrombosis in the IVT group (n = 29). The cumulative incidence of thrombosis was significantly higher in the IVP group (p < 0.01). Cox regression revealed that not receiving iliac vascular transposition was the only significant risk factor for thrombosis (odds ratio: 10.1, 95% confidence interval: 1.27-81.2; p = 0.03). One-year graft survival was significantly better in the IVT group vs IVP group (p = 0.03). CONCLUSIONS IVT in pancreas transplantation is a simple technique that results in a lower thrombosis risk and better graft survival rates without heparin-based anticoagulation therapy.
Collapse
|
4
|
Argente-Pla M, Martínez-Millana A, Espí-Reig J, Maupoey-Ibáñez J, Moya-Herráiz Á, Beneyto-Castello I, López-Andújar R, Merino-Torres JF. Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana. Cir Esp 2021; 99:666-677. [PMID: 34674986 DOI: 10.1016/j.cireng.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.1 ± 3.4 kg/m2, mean duration of diabetes 25.5 ± 6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91.3%, 91.3% and 89.5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2% and 93.6% at one year, 88.2% and 93.7% at 3 years, and 85.3% and 93.7% at 5 years, respectively (P = 1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2%, 69.1% and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5% and 80.6% at one year, 64.7% and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P = .0109). Post-transplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS In 13 years' experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.
Collapse
Affiliation(s)
- María Argente-Pla
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, Spain.
| | | | - Jordi Espí-Reig
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Javier Maupoey-Ibáñez
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Moya-Herráiz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Rafael López-Andújar
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Francisco Merino-Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, Spain; Departament de Medicina, Universitat de València, Valencia, Spain
| |
Collapse
|
5
|
Briceño J, Sánchez-Hidalgo JM, Arjona-Sanchez A. Back-table surgery pancreas allograft for transplantation: Implications in complications. World J Transplant 2021; 11:1-6. [PMID: 33552938 PMCID: PMC7829682 DOI: 10.5500/wjt.v11.i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 02/06/2023] Open
Abstract
To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique. Back-table surgery for pancreatic graft is a complex, meticulous and laborious technique on which the success of implant surgery and perioperative results depends. The technique can be described in the following steps: Preparation of the sterile table, ex-situ inspection of the pancreas-spleen block, management of the duodenum, identification of the bile duct, preparation of the portal vein, preparation of the own graft arteries and anastomosis to the arterial graft, spleen management and graft preservation prior to implantation in the recipient. A careful inspection of the pancreas-spleen block should be performed. It is important to identify the stump of the main bile duct, the portal vein cuff, and the arrangement of the superior mesenteric artery and splenic artery. The redundant duodenum must be removed. The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft, two key points to prevent thrombosis. The section line of the arteries must be clean, without atherosclerosis, to prevent arterial thrombosis. The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue. The artery can be reconstructed by interposing a "Y" graft from the donor iliac artery; or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery. An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation: Thrombosis and graft pancreatitis.
Collapse
Affiliation(s)
- Javier Briceño
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | | | - Alvaro Arjona-Sanchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| |
Collapse
|
6
|
Shahrestani S, Hitos K, Hort A, Spike E, Gibbons TJ, Lendzion R, Yuen L, Pleass HC, Hawthorne WJ. Successful Expectant Management of Nonocclusive Thrombosis in Simultaneous Pancreas-Kidney Transplantation. Transplant Proc 2021; 53:371-378. [PMID: 33419574 DOI: 10.1016/j.transproceed.2020.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Simultaneous pancreas-kidney (SPK) transplantation can be complicated by thrombosis in the early post-transplant period. METHODS We performed a single-center retrospective study examining risk factors, management, and outcomes of modern era SPK transplants. We reviewed 235 recipients over 10 years (January 1, 2008, to September 1, 2017). We used multivariate analysis to examine donor, recipient, and operative risk factors for thrombosis. RESULTS Forty-one patients (17%) had a thrombosis diagnosed on postoperative imaging, but 61% of these patients (n = 25/41) did not lose their graft secondary to the thrombosis. Nine patients (22%) were managed with watchful waiting and serial imaging, 12 (29%) were managed with therapeutic anticoagulation, and 4 (10%) required laparotomy and graft thrombectomy. Sixteen of 235 pancreas grafts (6.8%) required pancreatectomy, and 10 of these cases occurred in the first half of the study, before 2012. The risk of thrombosis leading to graft loss increased 11.2-fold in recipients with a body mass index (calculated as weight in kilograms divided by height in meters squared) > 25 compared with others (odds ratio, 11.2; 95% CI, 1.1-116.7; P = .043). CONCLUSIONS The majority of SPK transplants (61%) complicated by thrombosis of the pancreatic graft were salvaged by use of imaging, anticoagulation, and in select cases, laparotomy and graft thrombectomy.
Collapse
Affiliation(s)
| | - Kerry Hitos
- Sydney Medical School, University of Sydney, Sydney, Australia; Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Amy Hort
- Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Erin Spike
- Department of Surgery, Westmead Hospital, Westmead, Australia
| | | | | | - Lawrence Yuen
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Henry C Pleass
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Wayne J Hawthorne
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia; Centre for Transplant & Renal Research, Westmead Institute for Medical Research, Westmead, Australia.
| |
Collapse
|
7
|
Argente-Pla M, Martínez-Millana A, Espí-Reig J, Maupoey-Ibáñez J, Moya-Herráiz Á, Beneyto-Castello I, López-Andújar R, Merino-Torres JF. Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana. Cir Esp 2020; 99:S0009-739X(20)30312-2. [PMID: 33341241 DOI: 10.1016/j.ciresp.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4±5.7 years, mean BMI 24.1±3.4kg/m2, mean duration of diabetes 25.5±6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91,3, 91,3 and 89,5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2 and 93.6% at one year, 88.2 and 93.7% at 3 years, and 85.3 and 93.7% at 5 years, respectively (P=1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2, 69.1 and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5 and 80.6% at one year, 64.7 and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P=.0109). Postransplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS In 13-year's experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.
Collapse
Affiliation(s)
- María Argente-Pla
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, España; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, España.
| | | | - Jordi Espí-Reig
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Javier Maupoey-Ibáñez
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Ángel Moya-Herráiz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | | | - Rafael López-Andújar
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Juan Francisco Merino-Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, España; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, España; Departament de Medicina, Universitat de València, Valencia, España
| |
Collapse
|
8
|
Jiménez-Romero C, Marcacuzco Quinto A, Manrique Municio A, Justo Alonso I, Calvo Pulido J, Cambra Molero F, Caso Maestro Ó, García-Sesma Á, Moreno González E. Simultaneous pancreas-kidney transplantation. Experience of the Doce de Octubre Hospital. Cir Esp 2017; 96:25-34. [PMID: 29089105 DOI: 10.1016/j.ciresp.2017.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney transplantation (SPKT) constitutes the therapy of choice for diabetes type1 or type2 associated with end-stage renal disease, because is the only proven method to restore normo-glicemic control in the diabetic patient. METHODS Retrospective and descriptive study of a series of 175 patients who underwent SPKT from March 1995 to April 2016. We analyze donor and recipient characteristics, perioperative variables and immunosuppression, post-transplant morbi-mortality, patient and graft survival, and risk factors related with patient and graft survival. RESULTS Median age of the donors was 28years and mean age of recipients was 38.8±7.3years, being 103 males and 72 females. Enteric drainage of the exocrine pancreas was performed in 113 patients and bladder drainage in 62. Regarding post-transplant complications, the overall rate of infections was 70.3%; graft pancreatitis 26.3%; intraabdominal bleeding 17.7%; graft thrombosis 12.6%; and overall pancreas graft rejection 10.9%. The causes of mortality were mainly cardiovascular and infectious complications. Patient survival at 1, 3 and 5-year were 95.4%, 93% and 92.4%, respectively, and pancreas graft survival at 1, 3 and 5-year were 81.6%, 77.9% y 72.3%, respectively. CONCLUSIONS In our 20-year experience of simultaneous pancreas-kidney transplantation, the morbidity rate, and 5-year patient and pancreas graft survivals were similar to those previously reported from the international pancreas transplant registries.
Collapse
Affiliation(s)
- Carlos Jiménez-Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Alberto Marcacuzco Quinto
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Alejandro Manrique Municio
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Iago Justo Alonso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Jorge Calvo Pulido
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Félix Cambra Molero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Óscar Caso Maestro
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Álvaro García-Sesma
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Enrique Moreno González
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| |
Collapse
|
9
|
Multi detector computed tomography (MDCT) for the diagnosis of early complications after pancreas transplantation. ACTA ACUST UNITED AC 2015; 39:1186-92. [PMID: 24852313 DOI: 10.1007/s00261-014-0164-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Solitary Pancreas (SPT) and simultaneous kidney-pancreas (SPKT) transplants carry a high risk of surgical complications that may lead to the loss of the pancreas graft and impact later kidney function. The purpose of this study was to investigate the role of MDCT in the diagnosis of early complications and its impact on kidney function. METHODS All patients receiving SPT or SPKT over 5 years were retrospectively included. Complications that occurred within the first 15 days were registered and MDCT data analyzed. Data regarding donor, transplant, and recipient characteristics as well as transplantation procedures were analyzed according to the occurrence of early complications. Kidney function at day 3 following MDCT was evaluated. RESULTS One hundred and forty-one patients were included (85 men, 56 women; mean age 40.1 years, SD 7.7) with 119 SPKT and 22 SPT. Sixty-four complications were registered in 50 patients. Partial (P-) or complete venous thrombosis (C-VT) occurred in 12.1 % (n = 17), arterial thrombosis (AT) in 1.4 % (n = 2), and hemorrhage in 8.5 % (n = 12) of all patients. For venous thrombosis, the predominant risk factor was body mass index (BMI) for either recipients (P < 0.05) or donors (P < 0.01). Median time for venous thrombosis diagnosis with MDCT was 4 days. Kidney function was not altered following MDCT. Fourteen pancreatectomies were necessary. All patients with C-VT and AT had to undergo graftectomy. CONCLUSION Vascular complications occurred early following grafting. Systematic early-enhanced MDCT at day 2-3 should be adequate to detect early thrombosis, especially if risk factors have been identified, without induced kidney function alteration.
Collapse
|
10
|
Current world literature. Curr Opin Organ Transplant 2013; 18:111-30. [PMID: 23299306 DOI: 10.1097/mot.0b013e32835daf68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|