成功的同时胰腺-肾脏移植中非闭塞性血栓的期待治疗。

Successful Expectant Management of Nonocclusive Thrombosis in Simultaneous Pancreas-Kidney Transplantation.

机构信息

Sydney Medical School, University of Sydney, Sydney, Australia.

Sydney Medical School, University of Sydney, Sydney, Australia; Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Westmead, Australia.

出版信息

Transplant Proc. 2021 Jan-Feb;53(1):371-378. doi: 10.1016/j.transproceed.2020.10.042. Epub 2021 Jan 5.

DOI:10.1016/j.transproceed.2020.10.042

PMID:33419574

Abstract

BACKGROUND

Simultaneous pancreas-kidney (SPK) transplantation can be complicated by thrombosis in the early post-transplant period.

METHODS

We performed a single-center retrospective study examining risk factors, management, and outcomes of modern era SPK transplants. We reviewed 235 recipients over 10 years (January 1, 2008, to September 1, 2017). We used multivariate analysis to examine donor, recipient, and operative risk factors for thrombosis.

RESULTS

Forty-one patients (17%) had a thrombosis diagnosed on postoperative imaging, but 61% of these patients (n = 25/41) did not lose their graft secondary to the thrombosis. Nine patients (22%) were managed with watchful waiting and serial imaging, 12 (29%) were managed with therapeutic anticoagulation, and 4 (10%) required laparotomy and graft thrombectomy. Sixteen of 235 pancreas grafts (6.8%) required pancreatectomy, and 10 of these cases occurred in the first half of the study, before 2012. The risk of thrombosis leading to graft loss increased 11.2-fold in recipients with a body mass index (calculated as weight in kilograms divided by height in meters squared) > 25 compared with others (odds ratio, 11.2; 95% CI, 1.1-116.7; P = .043).

CONCLUSIONS

The majority of SPK transplants (61%) complicated by thrombosis of the pancreatic graft were salvaged by use of imaging, anticoagulation, and in select cases, laparotomy and graft thrombectomy.

摘要

背景

胰肾联合（SPK）移植后早期可能会发生血栓形成。

方法

我们进行了一项单中心回顾性研究，研究了现代 SPK 移植的危险因素、处理方法和结果。我们对 10 年来（2008 年 1 月 1 日至 2017 年 9 月 1 日）的 235 例受者进行了研究。我们采用多变量分析来研究供体、受者和手术相关的危险因素与血栓形成的关系。

结果

41 例（17%）受者术后影像学检查发现血栓，但其中 61%（25/41）的受者并未因血栓而丧失移植物。9 例（22%）患者采用观察等待和连续影像学检查，12 例（29%）患者接受抗凝治疗，4 例（10%）患者需要剖腹手术和移植物血栓切除术。235 例胰腺移植物中有 16 例（6.8%）需要行胰腺切除术，其中 10 例发生在研究的前半段（2012 年之前）。体重指数（BMI，体重除以身高的平方）＞25 的受者发生血栓导致移植物丧失的风险是其他受者的 11.2 倍（优势比，11.2；95%置信区间，1.1-116.7；P =.043）。