Detection, treatment and clinical outcome of graft thrombosis following pancreas transplantation

W.H. Kopp, C.A.T. van Leeuwen, H.D. Lam, V.A.L. Huurman, A.F.M. Schaapherder, A.G. Baranski, A.E. Braat

Wednesday 13 march 2019

14:14 - 14:16h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: Complete graft thrombosis is the leading cause of early graft loss following pancreas transplantation. Partial thrombosis is usually subclinical and discovered on routine imaging. Treatment options may vary in such cases. We describe the incidence and relevance of partial graft thrombosis in a large transplant center. 

Methods: All consecutive pancreas transplantation at our center (2004-2015) were included in this study. Standard clinical follow up includes computed tomography. Radiological follow-up, type and quantity of thrombosis prophylaxis, complications and graft and patient survival were collected. Partial thrombosis and follow-up were also studied.

Results: All 230 pancreas transplantations were included in the analysis. Computed tomography was performed in most cases (89.1%). Early graft failure occurred in 23 patients (13/23 due to graft thrombosis, 3/23 bleeding, 1/23 anastomotic leakage, 6/23 secondary to antibody mediated rejection). There was evidence of partial thrombosis in 59 cases (26%), of which the majority was treated with heparin and a vitamin K antagonist with graft preservation in 57/59 patients (97%). When CT imaging was performed per protocol (n=122), in 30 cases (25%), partial thrombosis was found.

Conclusions: Thrombosis is the leading cause of early graft loss following pancreas transplantation. Computed tomography allows for early detection of partial thrombosis, which is usually subclinical. Partial graft thrombosis occurs in about 25% of all cases. In this series, treatment with anticoagulant therapy (heparin and vitamin K antagonist) resulted in graft preservation in almost all cases.