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Tokodai K, Miyagi S, Nakanishi C, Hara Y, Nakanishi W, Miyazawa K, Shimizu K, Goto M, Kamei T, Unno M. The utility of superb microvascular imaging for monitoring low-velocity venous flow following pancreas transplantation: report of a case. J Med Ultrason (2001) 2018; 45:171-4. [DOI: 10.1007/s10396-017-0795-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/09/2017] [Indexed: 11/26/2022]
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Scheffert JL, Taber DJ, Pilch NA, Chavin KD, Baliga PK, Bratton CF. Clinical outcomes associated with the early postoperative use of heparin in pancreas transplantation. Transplantation. 2014;97:681-685. [PMID: 24285337 DOI: 10.1097/01.tp.0000437790.26255.5d] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Graft thrombosis following pancreas transplantation is the leading non-immunologic cause of graft loss. Routine systemic anticoagulation is controversial because of an increased bleeding risk. METHODS This was a retrospective, single-center analysis including all pancreas transplants performed over 9 years evaluating the use of low-dose heparin in the early postoperative period. Clinical outcomes were partial and complete graft thrombosis within 30 days, bleeding events, relaparotomy rates, and 30-day graft and patient survival. Multivariate regression analysis was performed to identify risk factors for early graft loss resulting from thrombosis. RESULTS One hundred fifty-two patients were included, 52 in the heparin group. The overall complete thrombosis rate was 13.1%, 10% in those who received heparin, and 15% in those who did not. Partial thrombosis was higher in the heparin group (10% vs. 3%). Higher relaparotomy rates were seen in the heparin group (29% vs. 22%); however, bleeding events were similar between groups. Graft and patient survival at 30 days were similar between groups; however, there was a trend toward higher graft survival in the heparin group. Heparin showed a trend toward a protective benefit for early graft loss resulting from thrombosis in all multivariate regression models. CONCLUSION These data suggest low-dose heparin early in the postoperative period may provide a protective benefit in the prevention of early graft loss resulting from thrombosis, without an increased risk of bleeding.
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Norton PT, Deangelis GA, Ogur T, Saad WE, Hagspiel KD. Noninvasive Vascular Imaging in Abdominal Solid Organ Transplantation. AJR Am J Roentgenol 2013; 201:W544-53. [DOI: 10.2214/ajr.13.11306] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Asher JF, Wilson CH, Talbot D, Manas DM, Williams R, White SA. Successful Endovascular Salvage of a Pancreatic Graft After a Venous Thrombosis: Case Report and Literature Review. EXP CLIN TRANSPLANT 2013; 11:375-8. [DOI: 10.6002/ect.2012.0234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fridell JA, Mangus RS, Mull AB, Taber TE, Sanders CE, Slisher RC, Goble ML, Powelson JA. Early reexploration for suspected thrombosis after pancreas transplantation. Transplantation. 2011;91:902-907. [PMID: 21301398 DOI: 10.1097/tp.0b013e3182106069] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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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Ciancio G, Monte AL, Julian J, Romano M, Miller J, Burke G. Vascular complications following bladder drained, simultaneous pancreas-kidney transplantation: the University of Miami experience. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02016.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hampson FA, Freeman SJ, Ertner J, Drage M, Butler A, Watson CJ, Shaw AS. Pancreatic transplantation: surgical technique, normal radiological appearances and complications. Insights Imaging 2010; 1:339-347. [PMID: 22347927 PMCID: PMC3259388 DOI: 10.1007/s13244-010-0046-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/05/2010] [Accepted: 09/18/2010] [Indexed: 12/23/2022] Open
Abstract
Pancreas transplantation is a surgical treatment for diabetes mellitus. More than 23,000 pancreas transplants have now been reported to the International Transplant Registry (IPTR). Early diagnosis and therapy for graft-related complications are essential for graft survival. Radiologists must therefore understand the surgical procedure and the potential complications. During the course of this review, we will illustrate the normal post-operative anatomy and the imaging appearances of common potential complications.
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Abstract
PURPOSE OF REVIEW The history of transplantation of the pancreas, unlike that of transplantation of other abdominal organs, has largely been shaped by the associated surgical complications. After more than three decades of progress, surgical-technical pancreas graft failure rates have decreased to approximately 8%. The most recent developments in this area are systematically reviewed in this article. RECENT FINDINGS Vascular graft thrombosis remains, by far, the most common cause of technical graft failure. Recent reports suggested that pancreas preservation with histidine-tryptophan-ketoglutarate solution (HTK) might be a risk factor for reperfusion pancreatitis, graft thrombosis and decreased short- and long-term graft survival. It remains unclear whether these results are, at least in part, related to HTK flush volumes and extended preservation (e.g.,>12 h). For selected thrombosed pancreas grafts, there has been renewed interest in pharmacological, interventional, and surgical salvage. For selected recipients with early pancreas graft thrombosis not amenable to a salvage intervention, transplant pancreatectomy in conjunction with immediate retransplantation has emerged as a viable option. For graft thrombosis prevention, the enhanced backtable pancreas vascular reconstruction techniques (e.g., gastroduodenal artery revascularization) proposed by some authors await more formal study. For prevention of native vascular complications in high-risk recipients, several technical modifications have been reported. Developments with respect to other surgical complications (wound infection, pancreatitis, leak, and bleeding) have been more incremental. CONCLUSION Recent evidence underscores the importance of judicious donor and recipient selection and of optimization of preservation and surgical factors for excellent short- and long-term pancreas transplant outcomes.
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Manrique A, Jiménez C, López RM, Cambra F, Morales JM, Andrés A, Gutiérrez E, Ortuño T, Calvo J, Sesma AG, Moreno E. Relaparotomy after pancreas transplantation: causes and outcomes. Transplant Proc 2009; 41:2472-4. [PMID: 19715955 DOI: 10.1016/j.transproceed.2009.06.165] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Surgical complications after pancreas transplantation, and subsequently relaparotomies, are frequently associated with graft loss, important morbidities, and occasionally patient death. PATIENTS AND METHODS From March 1995 to September 2008, 118 diabetic patients underwent pancreas transplantation: 109 simultaneous pancreas-kidney and nine pancreas after kidney. There were 68 men and 50 women. Mean age at transplantation was 37.8 +/- 7.8 years (range = 25-66). We analyzed donor and recipient characteristics, rate of relaparotomies, risk factors, as well as patient and graft survivals. RESULTS Forty patients (33.9%) underwent one or more relaparotomies. The causes for relaparotomy were: graft thrombosis in 15 patients (12.7%), bleeding in 14 (11.9%), duodenal stump leak in 7 (5.9%), severe pancreatitis and/or abscess in 5 (4.2%), and small bowel obstruction in 3 (2.5%). Graft pancreatectomy was performed in 52.5% (21 patients). The causes of graft loss were: graft thrombosis in 15 patients (12.7%), bleeding in 14 (11.9%), and duodenal stump leaks in 7 (5.9%). Mortality rate after relaparotomy was 3.38% (four patients). Relaparotomy rate for thrombosis was higher among the portoiliac than the portocaval vein anastomosis group (20.0% vs 10.2%; P = NS), and significantly higher for the bladder drainage than the enteric drainage technique (18.2% vs 5.8%; P < .05). Patients without relaparotomy experienced a significantly higher 5-year graft survival rate than those who underwent relaparotomy (87.2% vs 37.9%; P < .001), but 5-year patient survivals were similar (96.8% without relaparotomy vs 89.6% with relaparotomy). CONCLUSIONS Abdominal complications and the necessity for relaparotomy were associated with important morbidity and significantly reduced pancreas graft survival.
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Chandra J, Phillips RR, Boardman P, Gleeson FV, Anderson EM. Pancreas transplants. Clin Radiol 2009; 64:714-23. [PMID: 19520216 DOI: 10.1016/j.crad.2008.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/28/2008] [Accepted: 12/02/2008] [Indexed: 11/21/2022]
Abstract
Cadaveric, whole pancreas transplantation has proved an effective therapy in the treatment of long-standing type 1 diabetes mellitus and is capable of achieving an insulin-independent eugyclaemic state. As a result, this procedure is being increasingly performed. However, the surgical procedure is complex and unfamiliar to many radiologists. Imaging with computed tomography (CT) and magnetic resonance imaging (MRI) gives excellent results and can be used confidently to diagnose vascular, enteric, and immune-mediated complications. We present a review of the normal post-transplantation appearance and the features of early and late complications.
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Stockland AH, Willingham DL, Paz-Fumagalli R, Grewal HP, McKinney JM, Hughes CB, Walser EM. Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage. Cardiovasc Intervent Radiol 2009; 32:279-83. [DOI: 10.1007/s00270-009-9507-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 07/16/2008] [Accepted: 01/07/2009] [Indexed: 12/01/2022]
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Hagspiel KD, Nandalur K, Pruett TL, Leung DA, Angle JF, Spinosa DJ, Matsumoto AH, Ahmed H, Sanfey HA, Sawyer RG, Burkholder B, Brayman KL. Evaluation of vascular complications of pancreas transplantation with high-spatial-resolution contrast-enhanced MR angiography. Radiology 2007; 242:590-9. [PMID: 17255427 DOI: 10.1148/radiol.2422041261] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To retrospectively evaluate high-spatial-resolution contrast material-enhanced three-dimensional (3D) magnetic resonance (MR) angiography for assessment of vascular complications of pancreas allografts. MATERIALS AND METHODS The institutional review board approved the study and waived the requirement for informed patient consent owing to the retrospective nature of the study with use of an anonymous-subject database. The study was HIPAA compliant. The clinical and MR angiography findings in 11 patients (eight men, three women; mean age, 43 years; age range, 30-54 years) who had a history of pancreatic transplant dysfunction and underwent a total of 13 contrast-enhanced 3D MR angiography examinations were retrospectively reviewed. Comparison with conventional angiography findings was possible for four MR angiography examinations, comparison with surgical findings was possible for two examinations, and clinical follow-up was possible for all examinations. Two observers in consensus and blinded to the clinical results performed image analysis of the arterial and venous segments. Classification agreement was assessed with quadratic weighted kappa statistics. RESULTS Ten MR angiography examinations revealed vascular complications or signs suggestive of rejection. Only three examinations were considered to have completely normal results. All major complications were detected and included complete or partial arterial graft occlusion, stenosis of the arterial Y-graft caused by a kink, complete venous thrombosis, and arteriovenous fistula with pseudoaneurysm formation. For 46 arterial segments and 15 venous segments with angiographic and/or surgical comparison, overall agreement with MR angiography findings was nearly perfect (mean kappa, 0.983; standard error of the mean, 0.128). CONCLUSION High-spatial-resolution MR angiography of pancreas allografts enables assessment of the arterial and venous vascular anatomy and can be used to reliably identify clinically relevant vascular complications.
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Affiliation(s)
- Klaus D Hagspiel
- Department of Radiology and Division of Transplant Surgery, University of Virginia Health System, PO Box 800170, 1215 Lee St, Charlottesville, VA 22908, USA.
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Jiménez C, Manrique A, Herrero ML, Meneu JC, Abradelo M, Gutierrez E, Morales JM, Ortuño T, Praga M, Andrés A, Morales E, Moreno E. Incidence of Pancreas Graft Thrombosis in Portoiliac and Portocaval Venous Anastomosis. Transplant Proc 2005; 37:3977-8. [PMID: 16386602 DOI: 10.1016/j.transproceed.2005.10.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pancreas graft thromboses represent more than 70% of all technical failures; multiple risk factors have been implicated. We analyzed the thrombosis rates using portoiliac versus portocaval vein anastomoses. PATIENTS AND METHODS The series includes 53 patients who underwent pancreas transplantation: 49 simultaneous pancreas-kidney and 4 pancreas after kidney. There were 27 men and 26 women, of mean age of 37.2 +/- 7.0 years. We compared two groups of recipients that were classified according to venous anastomosis: (A) portoiliac (n = 30), and (B) portocaval (n = 23). RESULTS The recipients did not show significant differences in age, gender, or duration of diabetes mellitus, but body mass index was significantly higher among the portocaval group. A bladder-drained pancreas technique was more frequently performed in the portoiliac group (93% of patients) versus an enteric-drained pancreas in the portocaval group (81%; P < .001). Heparinization was performed in 12 recipients: 11 (36.6%) in the portoiliac group and 1 (4.3%) in the portocaval group (P < .01). Vascular graft thrombosis (venous in six and arterial in one) developed in seven patients (13.2%) all in the portoiliac group (23%) (P < .02). Two-year patient survival was 93% in the portoiliac group and 94% in portocaval group (P = NS). Two-year graft survival was 66.6% in the portoiliac group and 85.9% in portocaval group (P = .07). CONCLUSION There was no graft thrombosis among patients with a portocaval vein anastomosis.
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Affiliation(s)
- C Jiménez
- Servicio de Cirugía General, Ap. Digestivo y Trasplante de Organos Abdominales, Madrid, Spain.
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Abstract
OBJECTIVE The purpose of our study was to focus on the early diagnosis and treatment of vascular complications after simultaneous pancreas-kidney (SPK) transplantation. Description of the technique for salvage of the graft after venous thrombosis (VT) is also provided. METHODS From July 1994 to December 2002, 14 patients of 206 SPK transplant recipients had partial VT. Partial splenic VT (PSVT) was documented in 10 patients (4.8%), two had complete thrombosis of the splenic vein, one partial superior mesenteric thrombosis, and one developed partial thrombosis of the splenic and superior mesenteric vein. Four patients developed complete VT of the pancreas allograft and one superior mesenteric artery thrombosis. Our experience with four arteriovenous fistulae is also reported. The immunosuppression included tacrolimus, steroids, and monoclonal antibody to the IL-2 receptor. Thymoglobulin was introduced in June 2000 in our protocol combined with rapamycin or mycophenolate mofetil. These cases were identified following the intravenous (iv) use of tacrolimus with or without anti-IL-2R therapy. One case of complete VT is also reported one month following transplantation in a recipient with high rapamycin levels. Diagnosis was established during routine color Doppler ultrasonography. RESULTS Partial VT was effectively treated with anticoagulation. Complete VT required surgical thrombectomy. In our series, the pancreas was salvaged successfully in all patients with the technique described here. CONCLUSION Early diagnosis of vascular complications after pancreas transplantation is of paramount importance for the appropriate treatment with organ salvage. Based on our experience, we suggest that VT can be effectively treated with anticoagulation. Aspirin is sufficient for PSVT.
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Affiliation(s)
- Spiros Delis
- Department of Surgery, Agia Olga Hospital, Athens, Greece
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Gilabert R, Fernández-Cruz L, Real MI, Ricart MJ, Astudillo E, Montaña X. Treatment and outcome of pancreatic venous graft thrombosis after kidney--pancreas transplantation. Br J Surg 2002; 89:355-60. [PMID: 11872064 DOI: 10.1046/j.0007-1323.2001.02016.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreas venous graft thrombosis after transplantation is the main non-immunological cause of graft failure and usually results in pancreatectomy. Duplex Doppler ultrasonography is the primary imaging technique for monitoring vascular patency after pancreas transplantation. This study reports the results of rescue treatments for pancreas graft thrombosis after simultaneous pancreas--kidney transplantation. METHODS One hundred and ninety-six patients with insulin-dependent diabetes mellitus received a simultaneous pancreas--kidney transplantation. Venous graft thrombosis was diagnosed in 25 of these patients based on Doppler ultrasonographic findings. RESULTS Total venous graft thrombosis was diagnosed in 20 symptomatic patients, of whom 14 required graft pancreatectomy. Surgical thrombectomy was attempted in six patients with preserved arterial supply and was successful in four. Partial venous graft thrombosis was diagnosed in five asymptomatic patients; one also had partial splenic artery thrombosis. Rescue graft procedures included systemic anticoagulation (one patient), arterial thrombolysis (one) and venous thrombolysis and/or mechanical venous thrombectomy (four episodes in three patients). Graft rescue was achieved in three patients treated by venous thrombolysis/thrombectomy. CONCLUSION Doppler ultrasonography allows the appropriate selection of rescue treatment based on the findings of total or partial thrombosis.
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Affiliation(s)
- R Gilabert
- Imaging Diagnosis Center, Department of Surgery and Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Chao SH. Four-year results of pancreas transplantation in Taiwan. Transplant Proc 2000; 32:2467-8. [PMID: 11120247 DOI: 10.1016/s0041-1345(00)01746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S H Chao
- Department of Surgery, Jen-Ai Hospital and National Taiwan University Hospital, Taichung, Taiwan
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Ciancio G, Cespedes M, Olson L, Miller J, Burke GW. Partial venous thrombosis of the pancreatic allografts after simultaneous pancreas-kidney transplantation. Clin Transplant 2000; 14:464-71. [PMID: 11048991 DOI: 10.1034/j.1399-0012.2000.140504.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite new advances in transplantation, complete venous thrombosis (VT) of the pancreas after simultaneous pancreas kidney (SPK) transplantation usually results in graft loss. Data are limited regarding the outcome and treatment of partial VT of the pancreas allograft. From July 1994 to December 1999, 126 patients with IDDM/end-stage renal disease underwent SPK with systemic bladder drainage at the University of Miami. We retrospectively reviewed our experience regarding the outcome and treatment options of partial VT of the pancreas allografts. From July 1994 to April 1997, partial VT was not seen in the first 66 SPK patients induced with anti-CD3 rnAb and oral or intravenous (i.v.) tacrolimus (TAC) in the operating room. From May 1997 to June 1999, 14 (29%) out of 48 patients had VT. These cases were identified following the i.v. use of TAC with anti-IL-2R antibody-induction therapy (7/15) or without (7/33). Partial thrombosis of the splenic vein (PTSV) was documented in 10 patients, 2 had complete thrombosis of the splenic vein (CTSV), 1 had partial thrombosis of the superior mesenteric vein (PTSMV), and 1 patient had PTSV and PTSMV. These were identified incidentally during routine color Doppler ultrasonography (CDU). None of these SPK recipients demonstrates a change in clinical parameters. The first 8 patients were systemically heparinized, followed by oral anticoagulation, except 1 patient with CTSV. He progressed to complete thrombosis of the pancreas allograft and was treated with percutaneous thrombectomy and urokinase infusion, followed by heparinization and oral anticoagulation. One patient required exploration for bleeding. In an attempt to reduce the morbidity of heparinization, we treated the next 6 patients with PTSV with aspirin followed by serial CDU. All 14 patients had preservation of the endocrine and exocrine pancreatic functions. CDU showed resolution with recanalization of the thrombosed vein(s). From July 1999 to December 1999, 12 SPK recipients were administered TAC orally with or without induction therapy with anti-IL-2R antibody. So far, in this group, VT has not been identified. In summary, a total of 14 out of 126 patients (11%) had isolated VT with a mean follow-up of 36.4 months. Based on our experience, we suggest that extensive VT after pancreas transplantation, including splenic and superior mesenteric VT, be treated with heparin and subsequent oral anticoagulation for 3 months. For more limited, partial splenic VT, aspirin may be sufficient. Follow-up CDU is critical for a successful outcome. The i.v. use of TAC appears to be a risk factor for the increased incidence of VT. Currently, using IL-2rmAb as induction, TAC is started orally on postoperative days 3 or 4 and aspirin on postoperative day 2.
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Affiliation(s)
- G Ciancio
- Department of Surgery, University of Miami School of Medicine, FL 33101, USA.
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Eubank WB, Schmiedl UP, Levy AE, Marsh CL. Venous thrombosis and occlusion after pancreas transplantation: evaluation with breath-hold gadolinium-enhanced three-dimensional MR imaging. AJR Am J Roentgenol 2000; 175:381-5. [PMID: 10915679 DOI: 10.2214/ajr.175.2.1750381] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We describe the imaging findings of venous thrombosis and occlusion after pancreatic transplantation in five patients who underwent multiphasic breath-hold gadolinium-enhanced three-dimensional MR imaging. CONCLUSION Venous thrombus appeared as serpetine voids within the graft parenchyma or at the venous anastomosis during the venous phase of MR imaging. Nonenhancement or heterogeneous enhancement of graft parenchyma corresponded to glandular necrosis at pancreatectomy in two patients. Initial sonographic evaluation was nondiagnostic of venous thrombosis in two of five patients. Multiphasic breath-hold gadolinium-enhanced three-dimensional MR imaging of pancreatic transplants can provide information to make the specific diagnosis of venous thrombosis or occlusion.
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Affiliation(s)
- W B Eubank
- Department of Radiology, University of Washington School of Medicine, Seattle 98195-7115, USA
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Abstract
Argentina has a longstanding tradition of diabetes research, beginning with the seminal work of Prof. Bernardo A. Houssay, who was awarded the first Nobel Prize in Medical Sciences for his studies on the relationship between diabetes and pituitary function. Prof. Luis F. Leloir, who was also awarded the Nobel Prize for his work in carbohydrate metabolism, also inspired younger generations of biologists to work in the field of diabetes research. The aim of this paper is to provide a review of the contributions of Argentine researchers during the 1990s. This manuscript includes only reports of Argentine researchers working on diabetes in local laboratories and quoted in Medline. Thus, important contributions not reported in journals included in Medline or produced by Argentine researchers working abroad may have been omitted. The material consists of a brief description of clinical research (epidemiology and costs, metabolic control, associated risk factors, immunological aspects, and other clinical studies) and basic research (animal model with spontaneous diabetes, islet morphology and function in normal and pathological conditions, insulin action, metabolic disorders related to diabetes, and some miscellaneous effects related to drug-induced diabetes). Altogether, a broad idea of the continuous contribution of our national research to the international field of diabetes is provided, as well as a list of Argentine researchers and research centers devoted to the study of diabetes.
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Affiliation(s)
- J J Gagliardino
- CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET, WHO Collaborating Center), Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
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