Kjøsen Gisle, Rydenfelt Kristina, Horneland Rune, Aandahl Einar Martin, Line Pål-Dag, Dorenberg Eric, Berstad Audun Elnæs, Brabrand Knut, Hagen Gaute, Pischke Sören Erik, Bergmann Gisli Björn, Nordheim Espen, Jenssen Trond Geir, Tønnessen Tor Inge, Haugaa Håkon
Department of Anesthesiology, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
PLoS One. 2021 Mar 11;16(3):e0247615. doi: 10.1371/journal.pone.0247615. eCollection 2021.
Despite advances in immunosuppression and surgical technique, pancreas transplantation is encumbered with a high rate of complication and graft losses. Particularly, venous graft thrombi occur relatively frequently and are rarely detected before the transplant is irreversibly damaged.
To detect complications early, when the grafts are potentially salvageable, we placed microdialysis catheters anteriorly and posteriorly to the graft in a cohort of 34 consecutive patients. Glucose, lactate, pyruvate, and glycerol were measured at the bedside every 1-2 hours.
Nine patients with graft venous thrombosis had significant lactate and lactate-to-pyruvate-ratio increases without concomitant rise in blood glucose or clinical symptoms. The median lactate in these patients was significantly higher in both catheters compared to non-events (n = 15). Out of the nine thrombi, four grafts underwent successful angiographic extraction, one did not require intervention and four grafts were irreversibly damaged and explanted. Four patients with enteric anastomosis leakages had significantly higher glycerol measurements compared to non-events. As with the venous thrombi, lactate and lactate-to-pyruvate ratio were also increased in six patients with graft surrounding hematomas.
Bedside monitoring with microdialysis catheters is a promising surveillance modality of pancreatic grafts, but differentiating between the various pathologies proves challenging.
尽管免疫抑制和手术技术取得了进展，但胰腺移植仍存在高并发症发生率和移植物丢失的问题。特别是，静脉移植物血栓形成相对频繁，且在移植不可逆转地受损之前很少被检测到。
为了在移植物可能可挽救时早期检测并发症，我们在34例连续患者的移植物前后放置了微透析导管。每1 - 2小时在床边测量葡萄糖、乳酸、丙酮酸和甘油。
9例发生移植物静脉血栓形成的患者乳酸和乳酸与丙酮酸比值显著升高，而血糖或临床症状无相应升高。与未发生事件的患者（n = 15）相比，这些患者两根导管中的乳酸中位数均显著更高。在9例血栓中，4例移植物成功进行了血管造影取栓，1例无需干预，4例移植物不可逆转地受损并被切除。4例发生肠吻合口漏的患者甘油测量值显著高于未发生事件的患者。与静脉血栓形成情况一样，6例发生移植物周围血肿的患者乳酸和乳酸与丙酮酸比值也升高。
使用微透析导管进行床边监测是一种有前景的胰腺移植物监测方式，但区分各种病理情况具有挑战性。
