ISSN: 1859 - 2872
Case report: Venous thrombosis after simultaneous kidney and pancreas transplantation
Main Article Content
Keywords
Pancreas transplantation, ultaneous kidney and pancreas transplant, venous thrombosis of the graft
Abstract
Simultaneous pancreas-kidney transplantation is the gold standard for the treatment of late-stage diabetic nephropathy. Graft thrombosis is the major cause of early graft loss. We report a case of simultaneous pancreas-kidney transplantation from a brain-dead donor due to multiple trauma from a traffic accident to a 33-year-old female patient with type 1 diabetes mellitus for many years and stage 5 chronic renal failure. Although there were no significant clinical symptoms, the patient was found to have thrombosis of the pancreatic artery and vein on the POD4. Emergency endovascular intervention was performed to recanalize the graft but the thrombosis recurred. The pancreas graft was resected after complete necrosis was confirmed on the POD10. The patient recovered well after surgery. Several risk factors were assessed as being associated with thrombosis and were compared with the literature. Therefore, management and prevention of pancreatic graft thrombosis are important issues in addition to improving surgical techniques.
Article Details
References
1. Tydén G, Bolinder J, Solders G, Brattström C, Tibell A, Groth CG (1999) Improved survival in patients with insulin-dependent diabetes mellitus and end-stage diabetic nephropathy 10 years after combined pancreas and kidney transplantation. Transplantation 67: 645-648.
2. Stockland AH, Willingham DL, Paz-Fumagalli R, Grewal HP, McKinney JM, Hughes CB, Walser EM (2009) Pancreas transplant venous thrombosis: Role of endovascular interventions for graft salvage. Cardiovasc Intervent Radiol 32: 279-283.
3. Barrufet M, Burrel M, Angeles García-Criado M, Montañà X, Real MI, Ferrer J, Fernández-Cruz L, Gilabert R (2014) Pancreas transplants venous graft thrombosis: endovascular thrombolysis for graft rescue. Cardiovasc Intervent Radiol 37: 1226-1234.
4. Meirelles RF, Salvalaggio P & Pacheco-Silva A (2015) Pancreas transplantation: Review. Einstein (Sao Paulo) 13: 305-309.
5. Asher JF, Wilson CH, Talbot D, Manas DM, Williams R, White SA (2013) Successful endovascular salvage of a pancreatic graft after a venous thrombosis: Case report and literature review. Exp Clin Transplant 11: 375-378.
6. Gruessner AC & Sutherland DER (2005) Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant 19: 433-455.
7. Fridell JA, Mangus RS, Mull AB, Taber TE, Sanders CE, Slisher RC, Goble ML, Powelson JA (2011) Early reexploration for suspected thrombosis after pancreas transplantation. Transplantation 91: 902-907.
8. Maupoey Ibáñez J, Boscà Robledo A & López-Andujar R (2020) Late complications of pancreas transplant. World J Transplant 10: 404–414.
9. Bessems M, Doorschodt B M., Albers PS, Meijer J A & van Gulik TM (2006) Wash-out of the non-heart-beating donor liver: A matter of flush solution and temperature? Liver Int 26: 880-888 (2006).
10. Humar A, Kandaswamy R, Granger D, Gruessner RW, Gruessner AC, Sutherland DE (2002) Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 231: 269-275.
11. Reddy KS, Stratta RJ, Shokouh-Amiri, MH, Elmer D & Gaber AO (1999) Surgical complications after pancreas transplantation with portal-enteric drainage. Transplant Proc 31: 617-618 (1999).
12. Blundell J, Shahrestani S, Lendzion R, Pleass HJ & Hawthorne WJ (2020) Risk factors for early pancreatic allograft thrombosis following simultaneous pancreas-kidney transplantation: A systematic review. Clin Appl Thromb Hemost 26: 1076029620942589.
13. Ishibashi M, Ito T, Sugitani A, Furukawa H, Sekiguchi S, Gotoh M, Teraoka S, Sato Y, Matsuno N, Kenmochi S, Uchida H, Yoshimura N, Nakajima Y, Kuroda Y, Odan H, Idezuki Y, Kanazawa Y (2008) Present status of pancreas transplantation in Japan donation predominantly from marginal donors and modified surgical technique: Report of Japan pancreas transplantation registry. Transplant Proc 40: 486-490.
14. Gruessner RW, Sutherland DE, Troppmann C, Benedetti E, Hakim N, Dunn DL, Gruessner AC (1997) The surgical risk of pancreas transplantation in the cyclosporine era: an overview. J Am Coll Surg 185: 128-144.
15. Lin ZX, Kee M, Taber DJ, McGillicuddy JW, Chavin KD, Baliga PK, & Bratton CF (2013) Incidence, Risk factors and associated clinical outcomes of surgical complications following pancreas transplantation. Journal of Surgical Research 179: 196 (2013).
16. Finger EB, Radosevich D, Borja D, Dunn TB, Chinnakotla S, Sutherland DE, Pruett TL, Kandaswamy R (2012) Technical failure in pancreas transplantation: A composite model for predicting risk in the current era: 1825. Transplantation 94: 30.
17. Grewal HP, Garland L, Novak K, Gaber L, Tolley EA, Gaber AO (1993) Risk factors for postimplantation pancreatitis and pancreatic thrombosis in pancreas transplant recipients. Transplantation 56: 609-612.
18. Humar A, Ramcharan T, Kandaswamy R, Gruessner RW, Gruessner AC, Sutherland DE (2004) Technical failures after pancreas transplants: Why grafts fail and the risk factors a multivariate analysis. Transplantation 78: 1188-1192.
19. Raveh Y, Ciancio G, Burke GW, Figueiro J, Chen L, Morsi M, Namias N, Singh BP, Lindsay M, Alfahel W, Sleem MS, Nicolau-Raducu R (2019) Susceptibility-directed anticoagulation after pancreas transplantation: A single-center retrospective study. Clin Transplant 33: 13619.
20. Troppmann C, Gruessner AC, Benedetti E, Papalois BE, Dunn DL, Najarian JS, Sutherland DE, Gruessner RW (1996) Vascular graft thrombosis after pancreatic transplantation: Univariate and multivariate operative and nonoperative risk factor analysis. J Am Coll Surg 182: 285-316.
21. Ciancio G, Cespedes M, Olson L, Miller J & Burke GW (2000) Partial venous thrombosis of the pancreatic allografts after simultaneous pancreas-kidney transplantation. Clin Transplant 14: 464-471.
22. Hakeem A, Chen J, Iype S, Clatworthy MR, Watson CJE, Godfrey EM, Upponi S, Saeb-Parsy K (2018) Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm. Am J Transplant 18: 163-179.
23. Scheffert JL, Taber DJ, Pilch NA, Chavin KD, Baliga PK, Bratton CF (2014) Clinical outcomes associated with the early postoperative use of heparin in pancreas transplantation. Transplantation 97: 681-685.
24. Muthusamy, ASR, Giangrande PLF & Friend PJ (2010) Pancreas allograft thrombosis. Transplantation 90: 705-707.
25. Foshager MC, Hedlund LJ, Troppmann C, Benedetti E & Gruessner RW (1997) Venous thrombosis of pancreatic transplants: Diagnosis by duplex sonography. AJR Am J Roentgenol 169: 1269-1273.
26. Boggi U, Vistoli F, Signori S, Del Chiaro M, Campatelli A, Di Candio G, Morelli L, Coletti L, Amorese G, Vignali C, Cioni R, Petruzzi P, Barsotti M, Rizzo G, Marchetti P, Mosca F (2005) Surveillance and Rescue of pancreas grafts. Transplantation Proceedings 37: 2644–2647.
27. Margreiter C, Mark W, Wiedemann D, Sucher R, Öllinger R, Bösmüller C, Freund M, Maier HT, Greiner A, Fritsch H, Pratschke J, Margreiter R, Aigner F (2010) Pancreatic graft survival despite partial vascular graft thrombosis due to splenocephalic anastomoses. Am J Transplant 10 846–851 (2010).
28. Yoshimatsu R, Yamagami T, Terayama K, Matsumoto T, Miura H, Nishimura T, Okamoto M, Ushigome H, Nobori S, Yoshimura N (2009) Percutaneous transcatheter thrombolysis for graft thrombosis after pancreas transplantation. Pancreas 38: 597-599.
29. Han K, Ko HK, Tsauo J, Shim DJ, Kim Y, Ko GY, Han DJ, Shin S, Kim YH (2016) Endovascular management for the treatment of pancreas transplant venous thrombosis: A single-center experience. J Vasc Interv Radiol 27: 882-888.
2. Stockland AH, Willingham DL, Paz-Fumagalli R, Grewal HP, McKinney JM, Hughes CB, Walser EM (2009) Pancreas transplant venous thrombosis: Role of endovascular interventions for graft salvage. Cardiovasc Intervent Radiol 32: 279-283.
3. Barrufet M, Burrel M, Angeles García-Criado M, Montañà X, Real MI, Ferrer J, Fernández-Cruz L, Gilabert R (2014) Pancreas transplants venous graft thrombosis: endovascular thrombolysis for graft rescue. Cardiovasc Intervent Radiol 37: 1226-1234.
4. Meirelles RF, Salvalaggio P & Pacheco-Silva A (2015) Pancreas transplantation: Review. Einstein (Sao Paulo) 13: 305-309.
5. Asher JF, Wilson CH, Talbot D, Manas DM, Williams R, White SA (2013) Successful endovascular salvage of a pancreatic graft after a venous thrombosis: Case report and literature review. Exp Clin Transplant 11: 375-378.
6. Gruessner AC & Sutherland DER (2005) Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant 19: 433-455.
7. Fridell JA, Mangus RS, Mull AB, Taber TE, Sanders CE, Slisher RC, Goble ML, Powelson JA (2011) Early reexploration for suspected thrombosis after pancreas transplantation. Transplantation 91: 902-907.
8. Maupoey Ibáñez J, Boscà Robledo A & López-Andujar R (2020) Late complications of pancreas transplant. World J Transplant 10: 404–414.
9. Bessems M, Doorschodt B M., Albers PS, Meijer J A & van Gulik TM (2006) Wash-out of the non-heart-beating donor liver: A matter of flush solution and temperature? Liver Int 26: 880-888 (2006).
10. Humar A, Kandaswamy R, Granger D, Gruessner RW, Gruessner AC, Sutherland DE (2002) Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 231: 269-275.
11. Reddy KS, Stratta RJ, Shokouh-Amiri, MH, Elmer D & Gaber AO (1999) Surgical complications after pancreas transplantation with portal-enteric drainage. Transplant Proc 31: 617-618 (1999).
12. Blundell J, Shahrestani S, Lendzion R, Pleass HJ & Hawthorne WJ (2020) Risk factors for early pancreatic allograft thrombosis following simultaneous pancreas-kidney transplantation: A systematic review. Clin Appl Thromb Hemost 26: 1076029620942589.
13. Ishibashi M, Ito T, Sugitani A, Furukawa H, Sekiguchi S, Gotoh M, Teraoka S, Sato Y, Matsuno N, Kenmochi S, Uchida H, Yoshimura N, Nakajima Y, Kuroda Y, Odan H, Idezuki Y, Kanazawa Y (2008) Present status of pancreas transplantation in Japan donation predominantly from marginal donors and modified surgical technique: Report of Japan pancreas transplantation registry. Transplant Proc 40: 486-490.
14. Gruessner RW, Sutherland DE, Troppmann C, Benedetti E, Hakim N, Dunn DL, Gruessner AC (1997) The surgical risk of pancreas transplantation in the cyclosporine era: an overview. J Am Coll Surg 185: 128-144.
15. Lin ZX, Kee M, Taber DJ, McGillicuddy JW, Chavin KD, Baliga PK, & Bratton CF (2013) Incidence, Risk factors and associated clinical outcomes of surgical complications following pancreas transplantation. Journal of Surgical Research 179: 196 (2013).
16. Finger EB, Radosevich D, Borja D, Dunn TB, Chinnakotla S, Sutherland DE, Pruett TL, Kandaswamy R (2012) Technical failure in pancreas transplantation: A composite model for predicting risk in the current era: 1825. Transplantation 94: 30.
17. Grewal HP, Garland L, Novak K, Gaber L, Tolley EA, Gaber AO (1993) Risk factors for postimplantation pancreatitis and pancreatic thrombosis in pancreas transplant recipients. Transplantation 56: 609-612.
18. Humar A, Ramcharan T, Kandaswamy R, Gruessner RW, Gruessner AC, Sutherland DE (2004) Technical failures after pancreas transplants: Why grafts fail and the risk factors a multivariate analysis. Transplantation 78: 1188-1192.
19. Raveh Y, Ciancio G, Burke GW, Figueiro J, Chen L, Morsi M, Namias N, Singh BP, Lindsay M, Alfahel W, Sleem MS, Nicolau-Raducu R (2019) Susceptibility-directed anticoagulation after pancreas transplantation: A single-center retrospective study. Clin Transplant 33: 13619.
20. Troppmann C, Gruessner AC, Benedetti E, Papalois BE, Dunn DL, Najarian JS, Sutherland DE, Gruessner RW (1996) Vascular graft thrombosis after pancreatic transplantation: Univariate and multivariate operative and nonoperative risk factor analysis. J Am Coll Surg 182: 285-316.
21. Ciancio G, Cespedes M, Olson L, Miller J & Burke GW (2000) Partial venous thrombosis of the pancreatic allografts after simultaneous pancreas-kidney transplantation. Clin Transplant 14: 464-471.
22. Hakeem A, Chen J, Iype S, Clatworthy MR, Watson CJE, Godfrey EM, Upponi S, Saeb-Parsy K (2018) Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm. Am J Transplant 18: 163-179.
23. Scheffert JL, Taber DJ, Pilch NA, Chavin KD, Baliga PK, Bratton CF (2014) Clinical outcomes associated with the early postoperative use of heparin in pancreas transplantation. Transplantation 97: 681-685.
24. Muthusamy, ASR, Giangrande PLF & Friend PJ (2010) Pancreas allograft thrombosis. Transplantation 90: 705-707.
25. Foshager MC, Hedlund LJ, Troppmann C, Benedetti E & Gruessner RW (1997) Venous thrombosis of pancreatic transplants: Diagnosis by duplex sonography. AJR Am J Roentgenol 169: 1269-1273.
26. Boggi U, Vistoli F, Signori S, Del Chiaro M, Campatelli A, Di Candio G, Morelli L, Coletti L, Amorese G, Vignali C, Cioni R, Petruzzi P, Barsotti M, Rizzo G, Marchetti P, Mosca F (2005) Surveillance and Rescue of pancreas grafts. Transplantation Proceedings 37: 2644–2647.
27. Margreiter C, Mark W, Wiedemann D, Sucher R, Öllinger R, Bösmüller C, Freund M, Maier HT, Greiner A, Fritsch H, Pratschke J, Margreiter R, Aigner F (2010) Pancreatic graft survival despite partial vascular graft thrombosis due to splenocephalic anastomoses. Am J Transplant 10 846–851 (2010).
28. Yoshimatsu R, Yamagami T, Terayama K, Matsumoto T, Miura H, Nishimura T, Okamoto M, Ushigome H, Nobori S, Yoshimura N (2009) Percutaneous transcatheter thrombolysis for graft thrombosis after pancreas transplantation. Pancreas 38: 597-599.
29. Han K, Ko HK, Tsauo J, Shim DJ, Kim Y, Ko GY, Han DJ, Shin S, Kim YH (2016) Endovascular management for the treatment of pancreas transplant venous thrombosis: A single-center experience. J Vasc Interv Radiol 27: 882-888.
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Published
Dec 30, 2024
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How to Cite
LinhH. V., DươngT. T., TrungN. Đình, ThànhL. V., QuangV. V., HiếuL. T., AnhN. T., HạnhT. T. H., & Huy Đoàn T. (2024). Case report: Venous thrombosis after simultaneous kidney and pancreas transplantation . Tạp Chí Y Dược lâm sàng 108, 19(8). https://doi.org/10.52389/ydls.v19i8.2491