Delis Spiros, Dervenis Christos, Bramis John, Burke George W, Miller Joshua, Ciancio Gaetano
Department of Surgery, Agia Olga Hospital, Athens, Greece.
Pancreas. 2004 May;28(4):413-20. doi: 10.1097/00006676-200405000-00010.
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.
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.
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.
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.
我们研究的目的是专注于胰肾联合移植（SPK）术后血管并发症的早期诊断和治疗。同时还介绍了静脉血栓形成（VT）后挽救移植物的技术。
1994年7月至2002年12月，206例SPK移植受者中有14例发生部分VT。10例（4.8%）记录为部分脾静脉血栓形成（PSVT），2例脾静脉完全血栓形成，1例肠系膜上静脉部分血栓形成，1例脾静脉和肠系膜上静脉部分血栓形成。4例发生胰腺移植完全VT，1例发生肠系膜上动脉血栓形成。还报告了我们处理4例动静脉瘘的经验。免疫抑制方案包括他克莫司、类固醇和抗白细胞介素-2受体单克隆抗体。2000年6月在我们的方案中引入了抗胸腺细胞球蛋白，联合雷帕霉素或霉酚酸酯。这些病例是在静脉使用他克莫司联合或不联合抗白细胞介素-2受体治疗后发现的。还报告了1例雷帕霉素水平高的受者移植后1个月发生完全VT的病例。通过常规彩色多普勒超声检查确诊。
部分VT通过抗凝有效治疗。完全VT需要手术取栓。在我们的系列中，采用本文所述技术，所有患者的胰腺均成功挽救。
胰腺移植后血管并发症的早期诊断对于采用器官挽救的适当治疗至关重要。根据我们的经验，我们建议VT可以通过抗凝有效治疗。阿司匹林对PSVT足够。
