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Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm.

Accepted version
Peer-reviewed

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Authors

Hakeem, A 
Chen, J 
Iype, S 
Clatworthy, MR 
Watson, CJE 

Abstract

Pancreatic allograft thrombosis (PAT) remains the leading cause of nonimmunologic graft failure. Here, we propose a new computed tomography (CT) grading system of PAT to identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplantations between 2009 and 2014. Triple-phase CT scans were graded independently by 2 radiologists as grade 0, no thrombosis; grade 1, peripheral thrombosis; grade 2, intermediate non-occlusive thrombosis; and grade 3, central occlusive thrombosis. Twenty-four (23.3%) of 103 recipients were diagnosed with PAT (including grade 1). Three (2.9%) grafts were lost due to portal vein thrombosis. On multivariate analysis, pancreas after simultaneous pancreas-kidney transplantation/solitary pancreatic transplantation, acute rejection, and CT findings of peripancreatic edema and/or inflammatory change were significant risk factors for PAT. Retrospective review of CT scans revealed more grade 1 and 2 thromboses than were initially reported. There was no significant difference in graft or patient survival, postoperative stay, or morbidity of recipients with grade 1 or 2 thrombosis who were or were not anticoagulated. Our data suggest that therapeutic anticoagulation is not necessary for grade 1 and 2 arterial and grade 1 venous thrombosis. The proposed grading system can assist clinicians in decision-making and provide standardized reporting for future studies.

Description

Keywords

clinical research/practice, coagulation and hemostasis, complication, graft survival, health services and outcomes research, pancreas/simultaneous pancreas-kidney transplantation, thrombosis and thromboembolism, Adolescent, Adult, Algorithms, Allografts, Child, Female, Follow-Up Studies, Graft Rejection, Graft Survival, Humans, Male, Middle Aged, Pancreas Transplantation, Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, Thrombosis, Tomography, X-Ray Computed, Young Adult

Journal Title

Am J Transplant

Conference Name

Journal ISSN

1600-6135
1600-6143

Volume Title

18

Publisher

Elsevier BV