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How to Avoid Graft Thrombosis Requiring Graftectomy: Immediate Post Transplant CT Angiography in Pancreas Transplantation.

1 Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea. 2 Department of Radiology, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea. 3 Address correspondence to: Duck Jong Han, M.D., Ph.D., Department of Surgery, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, Korea 138-736.
Transplantation (Impact Factor: 3.78). 10/2012; 94(9). DOI: 10.1097/TP.0b013e3182692b4d
Source: PubMed

ABSTRACT BACKGROUND: Graft thrombosis immediately after surgery remains a problem for successful pancreas transplantation. The present study evaluated the efficacy of computed tomography (CT) angiography for monitoring of graft patency in the immediate postoperative period. METHODS: The study involved 119 patients who underwent pancreas transplantation between July 1992 and December 2009 in a single center. The anticoagulation strategy was heparin during and after transplantation and then oral warfarin for 1 to 6 months. Graft thrombosis was monitored using color Doppler ultrasonography until July 2005 (group A) and, thereafter, using CT angiography (group B). We retrospectively analyzed the efficacy of diagnosis of graft thrombosis in two groups. Graft survival was assessed using Kaplan-Meier analysis. RESULTS: Group A comprised 51 patients, and group B comprised 68 patients. Total vascular thrombosis was diagnosed in three (5.9%) group A and one (1.4%) group B patients, and partial venous thrombosis was diagnosed in 1 (2.0%) group A and 19 (31.6%) group B patients. Eighteen of the 19 grafts with partial thrombosis in group B were successfully treated using heparin-based anticoagulant therapy. There were no CT contrast media-related complications in group B. In group B, graft survival rates were the same for grafts with partial thrombosis and grafts without thrombosis. CONCLUSION: CT angiography was safe and effective for evaluating graft patency after pancreas transplantation. Partial vascular thrombosis in the immediate posttransplantation period showed no effect on graft survival under intensive anticoagulation and monitoring by CT angiography.

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