Ciancio G, Lo Monte A, Julian J F, Romano M, Miller J, Burke G W
Department of Surgery, University of Miami School of Medicine, and the Miami Veterans Administration, Medical Center, Florida, USA.
Transpl Int. 2000;13 Suppl 1:S187-90. doi: 10.1007/s001470050322.
Vascular complications remain a significant nonimmunologic source of pancreas allograft loss. From February 1993 through January 1998, we performed 98 simultaneous pancreas-kidney transplantations (SPK) using pancreatic exocrine bladder drainage in patients with type 1 insulin-dependent diabetes mellitus and end-stage renal disease. They originally received quadruple immunosuppression, and since May 1997 triple immunosuppression protocol (tacrolimus, mycophenolate mofetil, and steroids). The patients' mean age was 37 years (range 24-53 years), including 50 women and 48 men with a mean follow-up of 42 months. The overall rate of vascular complications was 6% (5 patients). The vascular complications were as follows: late thrombosis of the Y with persistent pancreas allograft function (n = 1), rupture of a pseudoaneurysm of the superior mesenteric artery (PSMA) with an arteriovenous fistula (AVF) (n = 1), thrombosis of the splenic vein (SV) (n = 3), complete thrombosis of the superior mesenteric vein (SMV) and splenic vein (n = 1). The patient with PSMA underwent surgical correction of the AVF and PSMA with preservation of the allograft pancreas function. The other patient with late thrombosis of the Y-graft required no treatment. All 3 patients with SV thrombosis were systemically heparinized followed by oral anticoagulation. The patient with complete thrombosis required surgical thrombectomy of the SMV and SV followed by heparinization and oral anticoagulation. All 6 patients including the 4 with thrombosis had preservation of the pancreas function. Serial pancreas ultrasound showed resolution and improvement with recanalization of the splenic vein and superior mesenteric vein in those patients with thrombosis. We describe our vascular experience with salvage of the pancreatic allograft function. Surgery seems to be the best treatment option in the case of AVF or complete thrombosis of the allograft. Intravenous heparin followed by oral anticoagultion could be a conservative approach for SV thrombosis.
血管并发症仍然是胰腺移植失败的一个重要非免疫因素。1993年2月至1998年1月，我们对1型胰岛素依赖型糖尿病合并终末期肾病患者进行了98例胰肾联合移植（SPK），采用胰腺外分泌膀胱引流术。患者最初接受四联免疫抑制治疗，自1997年5月起采用三联免疫抑制方案（他克莫司、霉酚酸酯和类固醇）。患者平均年龄37岁（范围24 - 53岁），其中女性50例，男性48例，平均随访42个月。血管并发症总发生率为6%（5例患者）。血管并发症如下：Y形血管晚期血栓形成且胰腺移植功能持续存在（n = 1），肠系膜上动脉假性动脉瘤（PSMA）破裂伴动静脉瘘（AVF）（n = 1），脾静脉（SV）血栓形成（n = 3），肠系膜上静脉（SMV）和脾静脉完全血栓形成（n = 1）。PSMA患者接受了AVF和PSMA的手术矫正，同时保留了移植胰腺的功能。另一名Y形移植血管晚期血栓形成的患者无需治疗。所有3例SV血栓形成患者均接受了全身肝素化治疗，随后口服抗凝药。完全血栓形成的患者需要对SMV和SV进行手术取栓，随后进行肝素化和口服抗凝治疗。包括4例血栓形成患者在内的所有6例患者均保留了胰腺功能。系列胰腺超声检查显示，血栓形成患者的脾静脉和肠系膜上静脉再通，血栓溶解并改善。我们描述了我们在挽救胰腺移植功能方面的血管治疗经验。对于AVF或移植血管完全血栓形成的情况，手术似乎是最佳治疗选择。静脉注射肝素随后口服抗凝药可能是治疗SV血栓形成的一种保守方法。
