Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm.
Am J Transplant
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Hakeem, A., Chen, J., Iype, S., Clatworthy, M., Watson, C., Godfrey, E., Upponi, S., & et al. (2018). Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm.. Am J Transplant, 18 (1), 163-179. https://doi.org/10.1111/ajt.14433
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.
Humans, Thrombosis, Postoperative Complications, Tomography, X-Ray Computed, Prognosis, Pancreas Transplantation, Risk Factors, Retrospective Studies, Follow-Up Studies, Graft Rejection, Graft Survival, Algorithms, Adolescent, Adult, Middle Aged, Child, Female, Male, Young Adult, Allografts
External DOI: https://doi.org/10.1111/ajt.14433
This record's URL: https://www.repository.cam.ac.uk/handle/1810/269835