Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
Eur J Radiol. 2021 Jan;134:109462. doi: 10.1016/j.ejrad.2020.109462. Epub 2020 Dec 2.
Although pancreas allograft thrombosis (PAT) incidence has progressively decreased, it remains the most common cause of early graft failure. Currently, there is no consensus on documentation of PAT, which has resulted in a great variability in reporting. The Cambridge Pancreas Allograft Thrombosis (CPAT) grading system has recently been developed for classification of PAT. In this study we aimed to assess the applicability and validate the reproducibility of the CPAT grading system.
This study is a retrospective cohort study. Selected for this study were all 177 pancreas transplantations performed at our center between January 1 st, 2008 and September 1 st, 2018 were included.
A total of 318 Computed Tomography (CT) images was reevaluated according the CPAT system by two local radiologists. Inter-rater agreement expressed in Cohen's kappa was 0.403 for arterial and 0.537 for venous thrombosis. Inter-rater agreement, expressed in the Fleiss' kappa, within clinically relevant thrombosis categories was 0.626 for Grade 2 and 0.781 for Grade 3 venous thrombosis.
Although not perfect, we believe that implementation of the CPAT system would improve current documentation on PAT. However, it is questionable whether identification of a small Grade 1 thrombosis would be relevant in clinical practice. Furthermore, a good quality CT scan, including adequate phasing, is essential to accurately identify potential thrombus and extend after pancreas transplantation.
尽管胰腺移植后血栓形成（PAT）的发生率逐渐降低，但它仍是导致早期移植物失功的最常见原因。目前，对于 PAT 的记录尚未达成共识，这导致报告结果存在很大的差异。最近开发了剑桥胰腺移植血栓形成（CPAT）分级系统，用于 PAT 的分类。本研究旨在评估 CPAT 分级系统的适用性和重现性。
这是一项回顾性队列研究。我们选择了 2008 年 1 月 1 日至 2018 年 9 月 1 日期间在我们中心进行的所有 177 例胰腺移植术进行了研究。
共有 318 例 CT 图像根据 CPAT 系统由两位当地放射科医生进行了重新评估。动脉血栓形成的两位评估者之间的一致性用 Cohen's kappa 表示为 0.403，静脉血栓形成的一致性用 Cohen's kappa 表示为 0.537。在临床相关的血栓形成类别中，两位评估者之间的一致性用 Fleiss' kappa 表示为 0.626（2 级）和 0.781（3 级）。
虽然不完美，但我们认为实施 CPAT 系统将改进当前关于 PAT 的记录。然而，在临床实践中，确定较小的 1 级血栓是否具有相关性仍存在疑问。此外，良好质量的 CT 扫描，包括适当的相位，对于准确识别潜在的血栓和延长胰腺移植后的时间至关重要。
