Aboalsamh Ghaleb, Anderson Patrick, Al-Abbassi Amira, McAlister Vivian, Luke Patrick P, Sener Alp
Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada.
Division of Urology, Department of Surgery, Western University, London, Canada.
Clin Transplant. 2016 Sep;30(9):1002-9. doi: 10.1111/ctr.12780. Epub 2016 Jul 11.
Thrombosis of the pancreas after transplantation is the most common cause of relaparotomy and resultant graft loss. There is currently no standard protocol consistently proven to prevent thrombosis following transplantation. Our objective was to determine whether our protocol of post-operative low-dose intravenous (IV) heparin infusion would prevent graft thrombosis without additional complications in our patients.
A total of 66 simultaneous pancreas kidney (SPK) transplants were performed at our institution from 2004 to 2014. Patients were divided into 2 retrospective cohort groups. Group 1 patients received only acetylsalicylic acid (ASA) 81 mg/d started on post-operative day 1. Group 2 patients received IV heparin infusion beginning in the recovery room at a rate of 500 IU/h for the first 24 hours, reduced by 100 IU/h every day to stop on day 5, and then received ASA 81 mg/d afterward. Outcome and complication rates were compared between the two groups for 5 years post-transplant.
We observed a significant reduction in graft thrombosis and graft loss with (0/29) patients in the heparin group vs (7/33) 25.7% from the non-heparin (P<.01) with no differences in complication rates.
We present a heparin infusion protocol which may help prevent graft thrombosis and graft loss in SPK transplantation.
胰腺移植后血栓形成是再次剖腹手术及最终移植物丢失的最常见原因。目前尚无经一致证实可预防移植后血栓形成的标准方案。我们的目标是确定我们术后低剂量静脉注射肝素输注方案是否能预防我们患者的移植物血栓形成且无额外并发症。
2004年至2014年在我们机构共进行了66例同期胰肾联合移植（SPK）。患者被分为2个回顾性队列组。第1组患者仅在术后第1天开始服用81毫克/天的阿司匹林（ASA）。第2组患者在恢复室开始静脉注射肝素，最初24小时以500国际单位/小时的速率输注，每天减少100国际单位/小时，至第5天停止，之后服用81毫克/天的ASA。比较两组移植后5年的结局和并发症发生率。
我们观察到肝素组（0/29）患者的移植物血栓形成和移植物丢失显著减少，而非肝素组为（7/33）25.7%（P<0.01），并发症发生率无差异。
我们提出了一种肝素输注方案，可能有助于预防SPK移植中的移植物血栓形成和移植物丢失。
