Background. Pancreas graft thrombosis is the most common cause of technical graft failure, with an incidence of up to 20% is some series. In most instances, vascular thrombosis of the graft will require immediate removal to avoid further abdominal complications. We present a total of four cases of complete venous thrombosis with preservation of function that were managed conservatively, resulting in long-term graft function.
Methods. Retrospective analysis of our case series over 10 years was carried out, obtaining patients with complete graft thrombosis by Doppler ultrasound. We included in the study only those patients who remained asymptomatic with preserved graft function. The clinical status of the patients, radiological findings, and therapeutic approach are evaluated. Patient and graft outcomes are analyzed.
Results. Retrospective evaluation of 227 transplants, a total of four patients were found to have complete thrombosis of the graft, remaining asymptomatic and preserving function without complications. Graft thrombosis was found on routine Doppler ultrasound evaluation of the transplanted organs at a median time of 19 days (range, 11–28 days), angiographic confirmation was obtained in all cases. The clinical condition and the presence of collateral flow allowed for conservative treatment. Median hospital stay was 29 days (range, 16–38 days), with a median follow-up of 106 months (range, 24–110 months), all patients are alive with a functioning graft.
Conclusions. In rare instances with complete thrombosis of the pancreas transplant in absence of clinical manifestations, the grafts can be closely monitored and treated with systemic anticoagulation, allowing long-term patient and graft survival.
1Department of Hepatobiliopancreatic Surgery and Transplantation, Hospital Clinic, Barcelona, Spain.
2Department of Surgery and Transplantation, Hospital Privado de Córdoba, Córdoba, Argentina.
3Department of Radiology, Hospital Clinico, Barcelona, Spain.
4Department of Interventional Radiology, Hospital Clinic, Barcelona, Spain.
5Department of Nephrology and Renal Transplant Unit, Hospital Clinic, Barcelona, Spain.
The authors declare no funding or conflicts of interest.
Address correspondence to: Raquel Garcia Roca, M.D., Departamento Cirugia General, ICMDiM, Hospital Clinic Barcelona, Villaroel 170, Barcelona 08036, Spain. E-mail: firstname.lastname@example.org
R.G.-R. and J.S. participated in data collection, data analysis, and writing of the manuscript. M.A.G.-C. and M.I.R. participated in the revision of the radiological findings and selection of key images. M.J.R. participated in the review of form and content.
Received 28 March 2011. Revision requested 20 April 2011.
Accepted 20 October 2011.