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Comandatore A, Palmeri M, Fatucchi LM, Campatelli A. Contrast Enhanced Ultrasound in Detecting Biliary Complications After ABO-Incompatible Liver Transplantation. Prog Transplant 2021; 31:283-284. [PMID: 34142609 DOI: 10.1177/15269248211024619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Annalisa Comandatore
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- General Surgery Unit, 90382Ospedale Versilia, Azienda USL Toscana Nordovest, Italy
| | - Lorenzo Maria Fatucchi
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Alessandro Campatelli
- Division of Diagnostic and Interventional Ultrasound in Transplantations, Azienda Ospedaliero-9310Universitaria Pisana, Pisa, Italy
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Pisano R, Gianardi D, Borrelli V, Guadagni S, Campatelli A. Posttransplant Renal Lymphangiectasia Presents Differently From Native Kidneys and Warrants Attention. Prog Transplant 2020; 31:95-96. [PMID: 33317390 DOI: 10.1177/1526924820978595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Roberta Pisano
- Division of Diagnostic and Interventional Ultrasound in Transplantations, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, 9257University of Pisa, Pisa, Italy
| | - Valerio Borrelli
- Division of Diagnostic and Interventional Ultrasound in Transplantations, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, 9257University of Pisa, Pisa, Italy
| | - Alessandro Campatelli
- Division of Diagnostic and Interventional Ultrasound in Transplantations, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Guadagni S, Gianardi D, Palmeri M, Furbetta N, Di Franco G, Bianchini M, Di Candio G. Contrast enhanced ultrasound for the diagnosis of bilateral renal lymphangiectasia: literature review and contrast enhanced ultrasound findings. J Ultrasound 2020; 25:111-114. [PMID: 32886346 PMCID: PMC8964914 DOI: 10.1007/s40477-020-00529-9] [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: 06/15/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023] Open
Abstract
Renal lymphangiectasia (RLmp) is a rare benign lymphatic malformation which should be distinguished from other more common pathologies. Ultrasound (US) examination can define the first diagnostic suspicion, but the definitive diagnosis is usually reached with a second level imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). We herein describe for the first time in literature, the use of the contrast enhanced ultrasound (CEUS) in disclosing the nature of peri-renal anechoic lesions in a 27-years old woman, that were initially confused with parenchymal cysts at B-Mode US. The diagnosis of RLmp may be particularly demanding due to its rarity and different clinical presentations. We suggest a possible role of CEUS as a real time, cost saving and easily accessible second level diagnostic tool, that can represent an appealing alternative in the diagnostic work up of suspected RLmp, respect to other imaging modalities.
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Affiliation(s)
- Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Desirée Gianardi
- grid.5395.a0000 0004 1757 3729General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Matteo Palmeri
- grid.5395.a0000 0004 1757 3729General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Niccolò Furbetta
- grid.5395.a0000 0004 1757 3729General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Gregorio Di Franco
- grid.5395.a0000 0004 1757 3729General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Matteo Bianchini
- grid.5395.a0000 0004 1757 3729General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulio Di Candio
- grid.5395.a0000 0004 1757 3729General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Furbetta N, Gianardi D, Bianchini M, Guadagni S. A Color Doppler Ultrasound Surveillance Protocol Can Improve the Graft Survival After Pancreas Transplantation. Prog Transplant 2019; 30:69-70. [PMID: 31829089 DOI: 10.1177/1526924819893318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Gianardi D, Bianchini M, Palmeri M, Di Franco G, Morelli L. Is there a role of robotic surgery in abdominal organs transplantations? J Robot Surg 2019; 14:677-678. [PMID: 31531754 DOI: 10.1007/s11701-019-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Desirée Gianardi
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy.
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy
- EndoCAS (Centre for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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Morelli L, Guadagni S, Gianardi D, Furbetta N, Di Franco G, Palmeri M, Bianchini M, Pisano R, Borrelli V, Campatelli A, Mosca F, Di Candio G. Gray-scale, Doppler and contrast-enhanced ultrasound in pancreatic allograft surveillance: A systematic literature review. Transplant Rev (Orlando) 2019; 33:166-172. [PMID: 30940408 DOI: 10.1016/j.trre.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gray scale ultrasound (US), Doppler and Contrast Enhanced Ultrasound (CEUS) represent important surveillance tools in the early post-operative period after pancreas transplantation (PTx), when complications are more common. This review summarizes the available evidence on their clinical application in this setting. METHODS We searched the Pub-Med database from inception to October 2018 for English literature on the clinical use of US, Doppler and CEUS in the post-PTx surveillance. Article selection was carried out according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses criteria (PRISMA). RESULTS Twenty-nine articles concerning the clinical applications of US, Doppler and CEUS were identified, 13 of which, involving 264 patients, were focused on the sonographic findings in immunologic rejection, whereas 11 studies reporting on 887 patients were focused on post-PTx vascular complications. The remaining five articles, involving a total of 196 patients, described US or CEUS applied in the study of pancreatic morphology and texture to diagnose peri-graft fluids collections or to obtain experimental data on allograft endocrine function. CONCLUSIONS US, Doppler and CEUS have proven to be valuable assets in post-PTx follow up, thanks to the combination of their non-invasiveness with a high accuracy in the detection of early abnormalities, in particular regarding vascular complications. Preliminary experiences are directing towards functional research; however, future prospective trials are necessary to precisely correlate organ perfusion, early abnormalities and allograft function.
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Affiliation(s)
- Luca Morelli
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy; EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Italy.
| | - Simone Guadagni
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Roberta Pisano
- Diagnostic and Interventional Ultrasound in Transplants Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Valerio Borrelli
- Diagnostic and Interventional Ultrasound in Transplants Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Campatelli
- Diagnostic and Interventional Ultrasound in Transplants Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
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Kopp WH, van Leeuwen CAT, Lam HD, Huurman VAL, de Fijter JW, Schaapherder AF, Baranski AG, Braat AE. Retrospective study on detection, treatment, and clinical outcome of graft thrombosis following pancreas transplantation. Transpl Int 2018; 32:410-417. [PMID: 30525250 PMCID: PMC7379998 DOI: 10.1111/tri.13384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/24/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022]
Abstract
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. All consecutive pancreas transplantation at our center (2004–2015) were included in this study. 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. 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%). 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.
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Affiliation(s)
- Wouter H Kopp
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hwai D Lam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Volkert A L Huurman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Andrzej G Baranski
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Techniques of pancreas graft salvage/indications for allograft pancreatectomy. Curr Opin Organ Transplant 2017; 21:405-11. [PMID: 27058314 DOI: 10.1097/mot.0000000000000318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Despite improvements in pancreas allograft outcome, graft complications remain a significant cause of morbidity and mortality. This review analyses the issues involved in the management of conditions that may require graft pancreatectomy, including the indications and techniques for graft salvage. RECENT FINDINGS With early recognition of graft complications, liberal use of radiological interventions, improved infection control, access to critical care and innovative surgical techniques, graft salvage is now feasible in many circumstances where graft pancreatectomy would previously have been necessary. SUMMARY The outcome of pancreas transplantation continues to improve with advances in the management of graft-threatening complications.
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Ferrer J, Molina V, Rull R, López-Boado MÁ, Sánchez S, García R, Ricart MJ, Ventura-Aguiar P, García-Criado Á, Esmatjes E, Fuster J, Garcia-Valdecasas JC. Pancreas transplantation: Advantages of a retroperitoneal graft position. Cir Esp 2017; 95:513-520. [PMID: 28688516 DOI: 10.1016/j.ciresp.2017.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/14/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In the 50 years since the first pancreas transplant performed at the University of Minnesota, the surgical techniques employed have undergone many modifications. Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the «native» pancreas. We herein present our experience of a modified technique for pancreatic transplant, with the organ placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodeno-duodenostomy. METHODS All pancreas transplantations performed between May 2016 and January 2017 were prospectively entered into our transplant database and retrospectively analyzed. RESULTS A total of 10 transplants were performed using the retroperitoneal technique (6 men: median age of 41 years [IQR 36-54]). Median cold ischemia times was 10,30h [IQR 5,30-12,10]. The preservation solution used was Celsior (n=7), IGL-1 (n=2), and UW (n=1). No complications related to the new surgical technique were identified. In one patient, transplantectomy at 12h was performed due to graft thrombosis, probably related to ischemic conditions from a donor with prolonged cardio-respiratory arrest. Another procedure was aborted without completing the graft implant due to an intraoperative immediate arterial thrombosis in a patient with severe iliac atheromatosis. No primary pancreas non-function occurred in the remaining 8patients. The median hospital stay was 13,50 days [IQR 10-27]. CONCLUSIONS Retroperitoneal graft placement appears feasible with easy access for dissection the vascular site; comfortable technical vascular reconstruction; and a decreased risk of intestinal obstruction by separation of the small bowel from the pancreas graft.
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Affiliation(s)
- Joana Ferrer
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - Víctor Molina
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Ramón Rull
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Miguel Ángel López-Boado
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Santiago Sánchez
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Rocío García
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Ma José Ricart
- Unidad de Trasplante Renal, Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Pedro Ventura-Aguiar
- Unidad de Trasplante Renal, Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Ángeles García-Criado
- Servicio de Radiología, Centro de Diagnóstico por la Imagen, Hospital Clínic, Barcelona, España
| | - Enric Esmatjes
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Barcelona, España
| | - Josep Fuster
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Juan Carlos Garcia-Valdecasas
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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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.
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Abstract
BACKGROUND Graft thrombosis is the most common cause of early graft loss after pancreas transplantation. Early reexploration may permit salvage or timely removal of the thrombosed graft. METHODS This was a retrospective review of 345 pancreas transplants performed at a single center between January 2003 and December 2009. Early reexploration was defined as within 1 week of pancreas transplantation. RESULTS Of the 345 transplants, there were 35 early reexplorations. The graft was compromised in 20 cases (57%): 10 venous thromboses, 3 arterial thromboses, 2 combined arterial and venous thrombosis, 2 thromboses secondary to allograft pancreatitis, and 3 cases of positional ischemia without thrombosis. Of these allografts, three reperfused once repositioned and six were successfully thrombectomized for a graft salvage rate of 45%. One of the thrombectomized grafts remained perfused but never functioned and was removed at retransplantation. The 10 remaining compromised grafts that were deemed unsalvageable and required allograft pancreatectomy. Nine of these recipients were retransplanted (eight within 2 weeks) and one was not a retransplantation candidate. CONCLUSIONS Reexploration for suspected graft thrombosis after pancreas transplantation resulted in a negative laparotomy rate of 43%, but permitted graft salvage in 45% of compromised grafts.
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Boggi U, Morelli L, Amorese G, Bargellini I, Marchetti P, Mosca F. Contribution of contrast-enhanced ultrasonography to nonoperative management of segmental ischemia of the head of a pancreas graft. Am J Transplant 2009; 9:413-8. [PMID: 19067661 DOI: 10.1111/j.1600-6143.2008.02475.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 32-year-old recipient of a pancreas transplant (PTx) alone was diagnosed with segmental graft ischemia, involving the head of the pancreas graft (HPG), based on color Doppler ultrasonography (CDU) and computed tomography (CT) angiography. For investigational purposes, graft supply was further checked by contrast-enhanced ultrasonography (CEU). Surprisingly, CEU showed collateral blood supply to the HPG starting from 40 s after contrast injection and resulting in homogenous parenchymography at 90 s. Full-dose heparin infusion, followed by long-term oral anticoagulation, allowed graft salvage without reoperation. At the longest follow-up of 18 months, the patient is insulin independent. This case report shows that CEU may be employed in PTx recipients suspected to harbor vascular complications. To the best of our knowledge, this is the first description of the use of CEU in PTx and the first description of graft salvage, without partial pancreatectomy after CDU and CT diagnosis of segmental graft ischemia.
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Affiliation(s)
- U Boggi
- Divisione di Chirurgia Generale e Trapianti nell'Uremico e nel Diabetico, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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Falk RJ, Hamm LL, Josephson MA, Adler S, Singh AK. The Nephrology Quiz and Questionnaire: 2006. Clin J Am Soc Nephrol 2007; 2:1375-88. [DOI: 10.2215/cjn.03310807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vasanthan A, Dallal N. Periodontal treatment considerations for cell transplant and organ transplant patients. Periodontol 2000 2007; 44:82-102. [PMID: 17474927 DOI: 10.1111/j.1600-0757.2006.00198.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Asvin Vasanthan
- Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, USA
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Kohler S, Pascher A, Neuhaus P. [Intensive care treatment following transplant surgery]. Chirurg 2006; 77:687-95. [PMID: 16821050 DOI: 10.1007/s00104-006-1209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Transplant-related intensive care treatment after transplantation of visceral organs, in Germany traditionally headed by transplant surgeons, is an integral part of postoperative therapy after liver, pancreas, intestinal, and combined organ transplantation, i.e. pancreas-kidney, liver-kidney, and multivisceral transplantation. Apart from adjustment and monitoring of immunosuppressive therapy, as well as common intensive care issues such as cardiopulmonary disease and complications, the avoidance, early detection, and rigorous treatment of transplant-related problems are the focus of surgical intensive care treatment of transplant patients. In the following article, its role after visceral organ transplantation is described regarding the most frequent transplant-related complications such as technical failure, various kinds of infection, and graft failure with different etiologies.
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Affiliation(s)
- S Kohler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin
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