Susceptibility-directed anticoagulation after pancreas transplantation: A single-center retrospective study

Yehuda Raveh, Gaetano Ciancio, George W. Burke, Jose Figueiro, Linda Chen, Mahmoud Morsi, Nicholas Namias, Bhavna P. Singh, Martine Lindsay, Waseem Alfahel, Mahmoud S. Sleem, Ramona Nicolau-Raducu

Research output: Contribution to journalArticle

Abstract

Pancreas transplant achieves consistent long-term euglycemia in type 1 diabetes. Allograft thrombosis (AT) causes the majority of early graft failure. We compared outcomes of four anticoagulation regimens administered to 95 simultaneous kidney-pancreas or isolated pancreas transplanted between 1/1/2015 and 11/20/2018. Early postoperative anticoagulation regimens included the following: none, subcutaneous heparin/aspirin, with or without dextran, and heparin infusion. The regimens were empirically selected based on each surgeon's assessment of hemostasis of the operative field and personal preference. A sonographic-based global scoring system of AT is presented. The 47-month recipients and graft survival were 95% and 86%, respectively. Recipients with or without AT had similar survival. Five and four grafts were lost due to death and AT, respectively. Outcomes of prophylaxis regimens correlated with intensity of anticoagulation. Compared with no anticoagulation, an increase in hemorrhagic complications occurred exclusively with iv heparin. The higher arterial AT score found in regimens lacking antiplatelet therapy highlights the importance of early antiaggregants therapy. Abnormal fibrinolysis was associated with an increase in AT score. Platelet dysfunction, warm ischemia time, and enteric drainage were predictive of AT and, along with other known risk factors, were incorporated into an algorithm that matches intensity of early postoperative anticoagulation to the thrombotic risk.

Original languageEnglish (US)
Article numbere13619
JournalClinical Transplantation
Volume33
Issue number7
DOIs
StatePublished - Jul 2019

Keywords

  • fibrinolytic shutdown
  • graft failure
  • pancreas transplantation
  • platelet dysfunction
  • thromboprophylaxis
  • thrombosis

ASJC Scopus subject areas

  • Transplantation

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