ISSN: 1859 - 2872
Trường hợp lâm sàng: Huyết khối tĩnh mạch mảnh ghép sau ghép tụy thận đồng thời từ người cho chết não
Main Article Content
Keywords
Ghép tụy, ghép tụy thận động thời, huyết khối tĩnh mạch mảnh ghép
Tóm tắt
Ghép tụy thận đồng thời là tiêu chuẩn vàng trong điều trị bệnh thận giai đoạn muộn do đái tháo đường. Huyết khối mảnh ghép là nguyên nhân chính dẫn đến mất mảnh ghép sớm. Báo cáo ca lâm sàng một trường hợp ghép tụy thận đồng thời từ một người hiến là bệnh nhân chết não, đa chấn thương do tai nạn giao thông cho một nữ bệnh nhân 33 tuổi mắc đái tháo đường type 1 nhiều năm đã có suy thận mạn giai đoạn 5. Mặc dù không có triệu chứng lâm sàng nào đáng kể, bệnh nhân đã được phát hiện huyết khối động mạch và tĩnh mạch tụy trên siêu âm Doppler mạch máu vào ngày hậu phẫu thứ 4. Can thiệp nội mạch cấp cứu đã được thực hiện nhằm tái thông mạch mảnh ghép nhưng huyết khối vẫn tái lập. Mảnh ghép tụy đã được cắt bỏ khi đã xác định hoại tử hoàn toàn vào ngày thứ 10 sau ghép. Sau phẫu thuật bệnh nhân hồi phục ổn định. Nhiều yếu tố nguy cơ được đánh giá là liên quan đến huyết khối và đối chiếu khi so sánh với y văn. Do đó, việc quản lí và dự phòng huyết khối mảnh ghép tụy là vấn đề quan trọng bên cạnh việc cải tiến kĩ thuật phẫu thuật.
Article Details
Các tài liệu tham khảo
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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