Preservation of Pancreas Graft Function After Complete Venous Thrombosis: Report of Four Cases Treated Conservatively

• Published in: Transplantation Vol. 93; no. 2; pp. 214 - 218
• Main Authors: GARCIA-ROCA, Raquel, SAMAME, Julia, GARCIA-CRIADO, Maria Angeles, REAL, Maria Isabel, GILABERT, Rosa, JOSE RICART, Maria
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 27-01-2012
• Subjects: Adolescent; Adult; Angiography; anticoagulants; Anticoagulants - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Collateral Circulation; complications; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Doppler effect; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Grafts; Hospitals; Humans; Kidney Transplantation; Male; Medical sciences; Middle Aged; Organs; Pancreas; Pancreas transplantation; Pancreas Transplantation - adverse effects; Pancreas Transplantation - physiology; Portal Vein; Preservation; Rejection; Retrospective Studies; Splenic Vein; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival; thromboembolism; Thrombosis; Tissue, organ and graft immunology; Tomography, X-Ray Computed; Ultrasonography, Doppler; Ultrasound; Venous Thrombosis - diagnosis; Venous Thrombosis - etiology; Venous Thrombosis - therapy; Preservation; Report; Complete; Cardiovascular disease; Venous disease; Vascular disease; Case study; Organ preservation; Treatment; Blood vessel; Surgery; Graft; Venous thrombosis; Circulatory system; Pancreas; Vein
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/TP.0b013e31823e46d1

Pancreas graft thrombosis is the most common cause of technical graft failure, with an incidence of up to 20% is some series. In most instances, vascular thrombosis of the graft will require immediate removal to avoid further abdominal complications. We present a total of four cases of complete venous thrombosis with preservation of function that were managed conservatively, resulting in long-term graft function.
Retrospective analysis of our case series over 10 years was carried out, obtaining patients with complete graft thrombosis by Doppler ultrasound. We included in the study only those patients who remained asymptomatic with preserved graft function. The clinical status of the patients, radiological findings, and therapeutic approach are evaluated. Patient and graft outcomes are analyzed.
Retrospective evaluation of 227 transplants, a total of four patients were found to have complete thrombosis of the graft, remaining asymptomatic and preserving function without complications. Graft thrombosis was found on routine Doppler ultrasound evaluation of the transplanted organs at a median time of 19 days (range, 11-28 days), angiographic confirmation was obtained in all cases. The clinical condition and the presence of collateral flow allowed for conservative treatment. Median hospital stay was 29 days (range, 16-38 days), with a median follow-up of 106 months (range, 24-110 months), all patients are alive with a functioning graft.
In rare instances with complete thrombosis of the pancreas transplant in absence of clinical manifestations, the grafts can be closely monitored and treated with systemic anticoagulation, allowing long-term patient and graft survival.