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dc.contributor.authorHakeem, A
dc.contributor.authorChen, J
dc.contributor.authorIype, S
dc.contributor.authorClatworthy, MR
dc.contributor.authorWatson, CJE
dc.contributor.authorGodfrey, EM
dc.contributor.authorUpponi, S
dc.contributor.authorSaeb-Parsy, K
dc.date.accessioned2017-11-30T13:45:08Z
dc.date.available2017-11-30T13:45:08Z
dc.date.issued2018-01
dc.identifier.issn1600-6135
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/269835
dc.description.abstractPancreatic 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.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherWiley
dc.subjectHumans
dc.subjectThrombosis
dc.subjectPostoperative Complications
dc.subjectTomography, X-Ray Computed
dc.subjectPrognosis
dc.subjectPancreas Transplantation
dc.subjectRisk Factors
dc.subjectRetrospective Studies
dc.subjectFollow-Up Studies
dc.subjectGraft Rejection
dc.subjectGraft Survival
dc.subjectAlgorithms
dc.subjectAdolescent
dc.subjectAdult
dc.subjectMiddle Aged
dc.subjectChild
dc.subjectFemale
dc.subjectMale
dc.subjectYoung Adult
dc.subjectAllografts
dc.titlePancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm.
dc.typeArticle
prism.endingPage179
prism.issueIdentifier1
prism.publicationDate2018
prism.publicationNameAm J Transplant
prism.startingPage163
prism.volume18
dc.identifier.doi10.17863/CAM.11417
dcterms.dateAccepted2017-07-11
rioxxterms.versionofrecord10.1111/ajt.14433
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-01
dc.contributor.orcidClatworthy, Menna [0000-0002-3340-9828]
dc.contributor.orcidWatson, Christopher [0000-0002-0590-4901]
dc.contributor.orcidSaeb-Parsy, Kourosh [0000-0002-0633-3696]
dc.identifier.eissn1600-6143
rioxxterms.typeJournal Article/Review
cam.issuedOnline2017-09-14
rioxxterms.freetoread.startdate2018-07-18


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