Vascular Complications of Pancreas Transplantation

Delis Spiros, Dervenis Christos, Bramis John, George W Burke, Joshua Miller, Gaetano Ciancio

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective: The purpose of our study was to focus on the early diagnosis and treatment of vascular complications after simultaneous pancreas-kidney (SPK) transplantation. Description of the technique for salvage of the graft after venous thrombosis (VT) is also provided. Methods: From July 1994 to December 2002, 14 patients of 206 SPK transplant recipients had partial VT. Partial splenic VT (PSVT) was documented in 10 patients (4.8%), two had complete thrombosis of the splenic vein, one partial superior mesenteric thrombosis, and one developed partial thrombosis of the splenic and superior mesenteric vein. Four patients developed complete VT of the pancreas allograft and one superior mesenteric artery thrombosis. Our experience with four arteriovenous fistulae is also reported. The immunosuppression included tacrolimus, steroids, and monoclonal antibody to the IL-2 receptor. Thymoglobulin was introduced in June 2000 in our protocol combined with rapamycin or mycophenolate mofetil. These cases were identified following the intravenous (iv) use of tacrolimus with or without anti-IL-2R therapy. One case of complete VT is also reported one month following transplantation in a recipient with high rapamycin levels. Diagnosis was established during routine color Doppler ultrasonography. Results: Partial VT was effectively treated with anticoagulation. Complete VT required surgical thrombectomy. In our series, the pancreas was salvaged successfully in all patients with the technique described here. Conclusion: Early diagnosis of vascular complications after pancreas transplantation is of paramount importance for the appropriate treatment with organ salvage. Based on our experience, we suggest that VT can be effectively treated with anticoagulation. Aspirin is sufficient for PSVT.

Original languageEnglish
Pages (from-to)413-420
Number of pages8
JournalPancreas
Volume28
Issue number4
DOIs
StatePublished - May 1 2004

Fingerprint

Pancreas Transplantation
Venous Thrombosis
Blood Vessels
Thrombosis
Pancreas
Tacrolimus
Sirolimus
Early Diagnosis
Splenic Vein
Mycophenolic Acid
Doppler Color Ultrasonography
Mesenteric Veins
Thrombectomy
Superior Mesenteric Artery
Interleukin-2 Receptors
Arteriovenous Fistula
Kidney Transplantation
Immunosuppression
Aspirin
Allografts

Keywords

  • Pancreas transplantation
  • Vascular complications
  • Vascular thrombosis

ASJC Scopus subject areas

  • Gastroenterology
  • Endocrinology

Cite this

Vascular Complications of Pancreas Transplantation. / Spiros, Delis; Christos, Dervenis; John, Bramis; Burke, George W; Miller, Joshua; Ciancio, Gaetano.

In: Pancreas, Vol. 28, No. 4, 01.05.2004, p. 413-420.

Research output: Contribution to journalArticle

Spiros, Delis ; Christos, Dervenis ; John, Bramis ; Burke, George W ; Miller, Joshua ; Ciancio, Gaetano. / Vascular Complications of Pancreas Transplantation. In: Pancreas. 2004 ; Vol. 28, No. 4. pp. 413-420.
@article{1d7baa9cf3344dc49e240adb1625bfe3,
title = "Vascular Complications of Pancreas Transplantation",
abstract = "Objective: The purpose of our study was to focus on the early diagnosis and treatment of vascular complications after simultaneous pancreas-kidney (SPK) transplantation. Description of the technique for salvage of the graft after venous thrombosis (VT) is also provided. Methods: From July 1994 to December 2002, 14 patients of 206 SPK transplant recipients had partial VT. Partial splenic VT (PSVT) was documented in 10 patients (4.8{\%}), two had complete thrombosis of the splenic vein, one partial superior mesenteric thrombosis, and one developed partial thrombosis of the splenic and superior mesenteric vein. Four patients developed complete VT of the pancreas allograft and one superior mesenteric artery thrombosis. Our experience with four arteriovenous fistulae is also reported. The immunosuppression included tacrolimus, steroids, and monoclonal antibody to the IL-2 receptor. Thymoglobulin was introduced in June 2000 in our protocol combined with rapamycin or mycophenolate mofetil. These cases were identified following the intravenous (iv) use of tacrolimus with or without anti-IL-2R therapy. One case of complete VT is also reported one month following transplantation in a recipient with high rapamycin levels. Diagnosis was established during routine color Doppler ultrasonography. Results: Partial VT was effectively treated with anticoagulation. Complete VT required surgical thrombectomy. In our series, the pancreas was salvaged successfully in all patients with the technique described here. Conclusion: Early diagnosis of vascular complications after pancreas transplantation is of paramount importance for the appropriate treatment with organ salvage. Based on our experience, we suggest that VT can be effectively treated with anticoagulation. Aspirin is sufficient for PSVT.",
keywords = "Pancreas transplantation, Vascular complications, Vascular thrombosis",
author = "Delis Spiros and Dervenis Christos and Bramis John and Burke, {George W} and Joshua Miller and Gaetano Ciancio",
year = "2004",
month = "5",
day = "1",
doi = "10.1097/00006676-200405000-00010",
language = "English",
volume = "28",
pages = "413--420",
journal = "Pancreas",
issn = "0885-3177",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Vascular Complications of Pancreas Transplantation

AU - Spiros, Delis

AU - Christos, Dervenis

AU - John, Bramis

AU - Burke, George W

AU - Miller, Joshua

AU - Ciancio, Gaetano

PY - 2004/5/1

Y1 - 2004/5/1

N2 - Objective: The purpose of our study was to focus on the early diagnosis and treatment of vascular complications after simultaneous pancreas-kidney (SPK) transplantation. Description of the technique for salvage of the graft after venous thrombosis (VT) is also provided. Methods: From July 1994 to December 2002, 14 patients of 206 SPK transplant recipients had partial VT. Partial splenic VT (PSVT) was documented in 10 patients (4.8%), two had complete thrombosis of the splenic vein, one partial superior mesenteric thrombosis, and one developed partial thrombosis of the splenic and superior mesenteric vein. Four patients developed complete VT of the pancreas allograft and one superior mesenteric artery thrombosis. Our experience with four arteriovenous fistulae is also reported. The immunosuppression included tacrolimus, steroids, and monoclonal antibody to the IL-2 receptor. Thymoglobulin was introduced in June 2000 in our protocol combined with rapamycin or mycophenolate mofetil. These cases were identified following the intravenous (iv) use of tacrolimus with or without anti-IL-2R therapy. One case of complete VT is also reported one month following transplantation in a recipient with high rapamycin levels. Diagnosis was established during routine color Doppler ultrasonography. Results: Partial VT was effectively treated with anticoagulation. Complete VT required surgical thrombectomy. In our series, the pancreas was salvaged successfully in all patients with the technique described here. Conclusion: Early diagnosis of vascular complications after pancreas transplantation is of paramount importance for the appropriate treatment with organ salvage. Based on our experience, we suggest that VT can be effectively treated with anticoagulation. Aspirin is sufficient for PSVT.

AB - Objective: The purpose of our study was to focus on the early diagnosis and treatment of vascular complications after simultaneous pancreas-kidney (SPK) transplantation. Description of the technique for salvage of the graft after venous thrombosis (VT) is also provided. Methods: From July 1994 to December 2002, 14 patients of 206 SPK transplant recipients had partial VT. Partial splenic VT (PSVT) was documented in 10 patients (4.8%), two had complete thrombosis of the splenic vein, one partial superior mesenteric thrombosis, and one developed partial thrombosis of the splenic and superior mesenteric vein. Four patients developed complete VT of the pancreas allograft and one superior mesenteric artery thrombosis. Our experience with four arteriovenous fistulae is also reported. The immunosuppression included tacrolimus, steroids, and monoclonal antibody to the IL-2 receptor. Thymoglobulin was introduced in June 2000 in our protocol combined with rapamycin or mycophenolate mofetil. These cases were identified following the intravenous (iv) use of tacrolimus with or without anti-IL-2R therapy. One case of complete VT is also reported one month following transplantation in a recipient with high rapamycin levels. Diagnosis was established during routine color Doppler ultrasonography. Results: Partial VT was effectively treated with anticoagulation. Complete VT required surgical thrombectomy. In our series, the pancreas was salvaged successfully in all patients with the technique described here. Conclusion: Early diagnosis of vascular complications after pancreas transplantation is of paramount importance for the appropriate treatment with organ salvage. Based on our experience, we suggest that VT can be effectively treated with anticoagulation. Aspirin is sufficient for PSVT.

KW - Pancreas transplantation

KW - Vascular complications

KW - Vascular thrombosis

UR - http://www.scopus.com/inward/record.url?scp=1942443726&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1942443726&partnerID=8YFLogxK

U2 - 10.1097/00006676-200405000-00010

DO - 10.1097/00006676-200405000-00010

M3 - Article

VL - 28

SP - 413

EP - 420

JO - Pancreas

JF - Pancreas

SN - 0885-3177

IS - 4

ER -