Thrombosis in human pancreatic transplantation associated with elevated cyclosporine levels and possible protection by antihypertensive agents.

Acute thrombosis in human pancreatic transplantation (HPT) remains a serious problem occurring in 10% to 30% of many reported series. Thrombosis may result from a number of causes including technical error, acute rejection, or low-flow states secondary to conditions within the host or in the transplanted organ. Evidence accumulates suggesting cyclosporine (CSA) acts as a potent vasoconstricting agent and that antihypertensive medications such as calcium channel blocking agents may offer protection from this effect. We have reviewed 68 consecutive human pancreatic transplants at the University of Iowa, specifically evaluating CSA levels, and the use or nonuse of antihypertensive medications. We found CSA levels in patients with transplant thrombosis to be elevated above the mean in 80% of patients with levels available 24 hours prior to thrombosis. Fifty percent of these (CSA) levels were well above one standard deviation. In addition, those patients receiving routine antihypertensive medication (most commonly calcium channel blocking agents) were statistically less likely to have thrombosis of the pancreatic transplant. We suggest that elevated levels of CSA may play at least a partial role in thrombosis of HPT and antihypertensive agents may offer protection from this effect.