单中心胰腺移植：与胰腺移植血栓形成相关的危险因素

Pancreas Transplantation in a Single Center: Risk Factors Associated With Pancreatic Allograft Thrombosis.

作者信息

Rocha-Santos Vinicius, Arantes Rubens Macedo, Waisberg Daniel Reis, Pantanali Carlos Andres, Pinheiro Rafael Soares, Nacif Lucas Souto, Ducatti Liliana, Andraus Wellington, Martino Rodrigo Bronze, Haddad Luciana Bertocco, Pereira Pedro Henrique, Ernani Lucas, Galvao Flavio Henrique, Nahas William Carlos, Carneiro-D'Albuquerque Luiz Augusto

机构信息

Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil.

出版信息

Transplant Proc. 2022 Apr;54(3):801-805. doi: 10.1016/j.transproceed.2022.01.013. Epub 2022 Mar 24.

DOI:10.1016/j.transproceed.2022.01.013

PMID:35339289

Abstract

BACKGROUND

Pancreas transplantation remains a challenging procedure for small and medium-sized transplants teams, despite improvements in graft survival. Data regarding the impact of the procurement team's experience on the outcomes of pancreas transplant are lacking. The objective of this study was to evaluate risk factors that lead to pancreatic allograft thrombosis, especially the experience of the pancreas procurement team.

METHODS

A retrospective study of 137 patients who underwent pancreas transplantation between March 2005 and May 2017 was conducted. Donor's and recipient characteristics were evaluated as well as their relationship to pancreatic allograft thrombosis. Cases were divided according to the number of pancreas procurements previously done by the procurement surgeon: group 1 (30 to 40 retrievals) and group 2 (≥40 retrievals).

RESULTS

Simultaneous pancreas-kidney transplants accounted for 89.8% of cases (n = 123). Surgeons from group 2 performed 62.8% (n = 86) of the procurements. The graft was removed in 19 cases (13.8%) due to thrombosis. In univariate analysis, lower experience of the retrieval team was associated with allograft loss (P = .04). In multivariate analysis, donor intensive care unit time ≥5 days (P = .03) and lower experience of the procurement team were associated with increased risk of pancreatic allograft thrombosis (P = .02), whereas recipient's age from 30 to 40 years (P = .018) or ≥40 years (P = .02) was found as a protective factor.

CONCLUSIONS

Pancreatic allograft thrombosis remains an important cause of graft loss in pancreas transplantation. Recipient's age, prolonged donor intensive care unit time, and lower experience of the procurement team directly influence pancreatic allograft thrombosis.

摘要

背景

尽管胰腺移植的移植物存活率有所提高，但对于中小型移植团队而言，胰腺移植仍是一项具有挑战性的手术。目前缺乏关于获取团队经验对胰腺移植结果影响的数据。本研究的目的是评估导致胰腺同种异体移植血栓形成的危险因素，尤其是胰腺获取团队的经验。

方法

对2005年3月至2017年5月期间接受胰腺移植的137例患者进行回顾性研究。评估供体和受体的特征以及它们与胰腺同种异体移植血栓形成的关系。根据获取外科医生之前进行的胰腺获取次数将病例分为两组：第1组（30至40次获取）和第2组（≥40次获取）。

结果

胰肾联合移植占病例的89.8%（n = 123）。第2组的外科医生进行了62.8%（n = 86）的获取手术。19例（13.8%）因血栓形成而移除移植物。在单因素分析中，获取团队经验较少与移植物丢失相关（P = 0.04）。在多因素分析中，供体重症监护病房时间≥5天（P = 0.03）和获取团队经验较少与胰腺同种异体移植血栓形成风险增加相关（P = 0.02），而受体年龄在30至40岁（P = 0.018）或≥40岁（P = 0.02）被发现是一个保护因素。