The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis

• Published in: Frontiers in immunology Vol. 15; p. 1359381
• Main Authors: Masset, Christophe, Branchereau, Julien, Buron, Fanny, Karam, Georges, Rabeyrin, Maud, Renaudin, Karine, Le Borgne, Florent, Badet, Lionel, Matillon, Xavier, Legendre, Christophe, Glotz, Denis, Antoine, Corinne, Giral, Magali, Dantal, Jacques, Cantarovich, Diego
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers 17-05-2024; Frontiers Media S.A
• Subjects: Adult; allograft thrombosis; Allografts; Angiotensin II; body mass index (BMI); Female; Graft Rejection - immunology; Graft Survival; high blood pressure; Humans; Hypertension - etiology; Immunology; immunothrombosis; Life Sciences; Male; Middle Aged; pancreas transplantation; Pancreas Transplantation - adverse effects; pre-procurement pancreas suitability score; Retrospective Studies; Risk Factors; Thrombosis - etiology; Tissue Donors; allograft thrombosis; pre-procurement pancreas suitability score; pancreas transplantation; high blood pressure; immunothrombosis; body mass index (BMI)
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2024.1359381

About 10-20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis.
We conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers.
Pancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers.
Donor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.