Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida.
Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida.
Clin Transplant. 2019 Jul;33(7):e13619. doi: 10.1111/ctr.13619. Epub 2019 Jun 23.
Pancreas transplant achieves consistent long-term euglycemia in type 1 diabetes. Allograft thrombosis (AT) causes the majority of early graft failure. We compared outcomes of four anticoagulation regimens administered to 95 simultaneous kidney-pancreas or isolated pancreas transplanted between 1/1/2015 and 11/20/2018. Early postoperative anticoagulation regimens included the following: none, subcutaneous heparin/aspirin, with or without dextran, and heparin infusion. The regimens were empirically selected based on each surgeon's assessment of hemostasis of the operative field and personal preference. A sonographic-based global scoring system of AT is presented. The 47-month recipients and graft survival were 95% and 86%, respectively. Recipients with or without AT had similar survival. Five and four grafts were lost due to death and AT, respectively. Outcomes of prophylaxis regimens correlated with intensity of anticoagulation. Compared with no anticoagulation, an increase in hemorrhagic complications occurred exclusively with iv heparin. The higher arterial AT score found in regimens lacking antiplatelet therapy highlights the importance of early antiaggregants therapy. Abnormal fibrinolysis was associated with an increase in AT score. Platelet dysfunction, warm ischemia time, and enteric drainage were predictive of AT and, along with other known risk factors, were incorporated into an algorithm that matches intensity of early postoperative anticoagulation to the thrombotic risk.
胰腺移植可使 1 型糖尿病患者长期保持血糖正常。同种异体移植物血栓形成（AT）是导致大多数早期移植物失功的原因。我们比较了在 2015 年 1 月 1 日至 2018 年 11 月 20 日期间接受 95 例同时肾胰腺或单纯胰腺移植的患者采用的四种抗凝方案的结果。术后早期抗凝方案包括：无抗凝、皮下肝素/阿司匹林、加或不加右旋糖酐和肝素输注。这些方案是根据每位外科医生对手术区域止血情况的评估和个人偏好经验性选择的。本文提出了一种基于超声的 AT 全球评分系统。患者和移植物的 47 个月存活率分别为 95%和 86%。有或没有 AT 的患者存活率相似。由于死亡和 AT，分别有 5 个和 4 个移植物丢失。预防方案的结果与抗凝强度相关。与无抗凝相比，仅静脉肝素会增加出血并发症。缺乏抗血小板治疗的方案中动脉 AT 评分较高，这突出了早期抗聚集治疗的重要性。纤溶异常与 AT 评分增加相关。血小板功能障碍、热缺血时间和肠引流与 AT 相关，与其他已知危险因素一起，被纳入一种算法，根据血栓形成风险调整术后早期抗凝强度。
