1 Department of Pharmacy, New York-Presbyterian Hospital, New York, NY. 2 Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC. 3 Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC. 4 Address correspondence to: David J. Taber, PharmD, Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 611/CSB 409, Charleston, SC 29425.
Transplantation. 2014 Mar 27;97(6):681-5. doi: 10.1097/01.TP.0000437790.26255.5d.
Graft thrombosis following pancreas transplantation is the leading non-immunologic cause of graft loss. Routine systemic anticoagulation is controversial because of an increased bleeding risk.
This was a retrospective, single-center analysis including all pancreas transplants performed over 9 years evaluating the use of low-dose heparin in the early postoperative period. Clinical outcomes were partial and complete graft thrombosis within 30 days, bleeding events, relaparotomy rates, and 30-day graft and patient survival. Multivariate regression analysis was performed to identify risk factors for early graft loss resulting from thrombosis.
One hundred fifty-two patients were included, 52 in the heparin group. The overall complete thrombosis rate was 13.1%, 10% in those who received heparin, and 15% in those who did not. Partial thrombosis was higher in the heparin group (10% vs. 3%). Higher relaparotomy rates were seen in the heparin group (29% vs. 22%); however, bleeding events were similar between groups. Graft and patient survival at 30 days were similar between groups; however, there was a trend toward higher graft survival in the heparin group. Heparin showed a trend toward a protective benefit for early graft loss resulting from thrombosis in all multivariate regression models.
These data suggest low-dose heparin early in the postoperative period may provide a protective benefit in the prevention of early graft loss resulting from thrombosis, without an increased risk of bleeding.
胰腺移植后移植物血栓形成是导致移植物丧失的主要非免疫性原因。由于出血风险增加，常规全身抗凝存在争议。
这是一项回顾性、单中心分析，包括 9 年来所有进行的胰腺移植，评估在术后早期使用低剂量肝素的情况。临床结果是 30 天内部分和完全移植物血栓形成、出血事件、再次剖腹手术率以及 30 天移植物和患者存活率。进行多变量回归分析，以确定血栓形成导致早期移植物丧失的危险因素。
共纳入 152 例患者，其中肝素组 52 例。总的完全血栓形成率为 13.1%，肝素组为 10%，未使用肝素组为 15%。肝素组部分血栓形成率较高（10%比 3%）。肝素组再次剖腹手术率较高（29%比 22%）；然而，两组出血事件相似。两组患者 30 天移植物和存活率相似；然而，肝素组移植物存活率有升高趋势。肝素在所有多变量回归模型中均显示出对血栓形成导致的早期移植物丧失具有保护作用的趋势。
这些数据表明，术后早期使用低剂量肝素可能有助于预防血栓形成导致的早期移植物丧失，而不会增加出血风险。
