Montiel-Casado M C, Fernández-Burgos I, Pérez-Daga J A, Aranda-Narváez J M, Sánchez-Pérez B, González-Sánchez A J, Cabello-Diaz M, Burgos-Rodríguez D, Hernández-Marrero D, Santoyo-Santoyo J
Digestive Surgery and Transplantation Department, University Hospital Carlos Haya, Malaga, Spain.
Transplant Proc. 2012 Nov;44(9):2627-30. doi: 10.1016/j.transproceed.2012.09.103.
Vascular graft thrombosis (VGT) is still the achuilles heel in pancreas transplantation (PT); it is the main cause of nonimmunologic graft loss. Early diagnosis is essential to avoid transplantectomy. The aim of our study was to analyze the peak amylase during the first 3 days after PT as risk factor for VGT.
This retrospective study included 58 pancreas transplants in 55 patients from January 2007 to November 2011. They underwent an anticoagulation protocol based on unfractionated heparin and low-molecular-weight heparin. The technique consisted of enteric drainage and systemic venous drainage. The primary endpoint was VGT with consideration of multiple relevant variables. The maximum amylase level was determined during the first 3 days after transplantation. A receiver operating characteristic analysis was performed to establish a cutoff point as (mean plus one standard deviation; 745 mg/dL), calculating the sensitivity, specificity, and predictive values.
Recipient characteristics were 71% males with an overall mean age of 39 years (range, 23-55) and body mass index 24 (range, 19-36). The donor sex was similar. Mean donor age was 32 years with occurrences of hypotension in 9%, cerebrovascular brain death in 46%. Mean ischemia time was 10 hours and 45 minutes. Mean blood amylase peak was 395 mg/dL. Seven VGT cases were diagnosed during the postoperative period including six with complete thrombosis requring transplantectomy. Bivariate analysis showed the group of subjects with amylase levels above 745 mg/dL to display on eight-fold greater risk for VGT (odds ratio = 8.6; P = .032). The area under the curve of blood amylase peak during the first 3 days to detect VGT was 0.630 (95% confidence interval 0.41-0.84).
A blood amylase peak above 745 mg/dL in the first 3 days after transplantation was associated with risk for VGT.
血管移植物血栓形成（VGT）仍是胰腺移植（PT）的致命弱点；它是非免疫性移植物丢失的主要原因。早期诊断对于避免移植切除至关重要。我们研究的目的是分析胰腺移植术后前3天的淀粉酶峰值作为血管移植物血栓形成的危险因素。
这项回顾性研究纳入了2007年1月至2011年11月期间55例患者的58例胰腺移植。他们接受了基于普通肝素和低分子肝素的抗凝方案。技术包括肠内引流和全身静脉引流。主要终点是考虑多个相关变量的血管移植物血栓形成。在移植后的前3天测定最大淀粉酶水平。进行受试者工作特征分析以确定截断点为（平均值加一个标准差；745mg/dL），计算敏感性、特异性和预测值。
受者特征为71%为男性，总体平均年龄为39岁（范围23 - 55岁），体重指数为24（范围19 - 36）。供者性别相似。供者平均年龄为32岁，9%出现低血压，46%出现脑血管脑死亡。平均缺血时间为10小时45分钟。平均血淀粉酶峰值为395mg/dL。术后期间诊断出7例血管移植物血栓形成病例，其中6例完全血栓形成需要进行移植切除。二元分析显示淀粉酶水平高于745mg/dL的受试者组发生血管移植物血栓形成的风险高8倍（优势比 = 8.6；P = 0.032）。移植后前3天血淀粉酶峰值检测血管移植物血栓形成的曲线下面积为0.630（95%置信区间0.41 - 0.84）。
移植后前3天血淀粉酶峰值高于745mg/dL与血管移植物血栓形成风险相关。
