Heparin infusion in simultaneous pancreas and kidney transplantation reduces graft thrombosis and improves graft survival

• Published in: Clinical transplantation Vol. 30; no. 9; pp. 1002 - 1009
• Main Authors: Aboalsamh, Ghaleb, Anderson, Patrick, Al-Abbassi, Amira, McAlister, Vivian, Luke, Patrick P., Sener, Alp
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01-09-2016
• Subjects: Adult; Canada - epidemiology; Dose-Response Relationship, Drug; Female; Fibrinolytic Agents - administration & dosage; Follow-Up Studies; graft loss; Graft Rejection - complications; Graft Rejection - diagnosis; Graft Rejection - epidemiology; Graft Survival; heparin; Heparin - administration & dosage; Humans; Incidence; Infusions, Intravenous; Kidney Transplantation - adverse effects; Male; pancreas transplantation; Pancreas Transplantation - adverse effects; Postoperative Complications; Retrospective Studies; Risk Factors; thromboprophylaxis; thrombosis; Thrombosis - epidemiology; Thrombosis - etiology; Thrombosis - prevention & control; Time Factors; heparin; pancreas transplantation; thrombosis; graft loss; thromboprophylaxis
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12780

Introduction
Thrombosis of the pancreas after transplantation is the most common cause of relaparotomy and resultant graft loss. There is currently no standard protocol consistently proven to prevent thrombosis following transplantation. Our objective was to determine whether our protocol of post‐operative low‐dose intravenous (IV) heparin infusion would prevent graft thrombosis without additional complications in our patients.
Methods
A total of 66 simultaneous pancreas kidney (SPK) transplants were performed at our institution from 2004 to 2014. Patients were divided into 2 retrospective cohort groups. Group 1 patients received only acetylsalicylic acid (ASA) 81 mg/d started on post‐operative day 1. Group 2 patients received IV heparin infusion beginning in the recovery room at a rate of 500 IU/h for the first 24 hours, reduced by 100 IU/h every day to stop on day 5, and then received ASA 81 mg/d afterward. Outcome and complication rates were compared between the two groups for 5 years post‐transplant.
Results
We observed a significant reduction in graft thrombosis and graft loss with (0/29) patients in the heparin group vs (7/33) 25.7% from the non‐heparin (P<.01) with no differences in complication rates.
Conclusions
We present a heparin infusion protocol which may help prevent graft thrombosis and graft loss in SPK transplantation.