Ghaleb Aboalsamh1, Patrick Anderson2, Amira Al-Abbassi1, Vivian McAlister1,3, Patrick P Luke1,2, Alp Sener4,5,6. 1. Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada. 2. Division of Urology, Department of Surgery, Western University, London, Canada. 3. Division of General Surgery, Department of Surgery, Western University, London, Canada. 4. Multi-Organ Transplant Program, London Health Sciences Center, Western University, London, Canada. alp.Sener@lhsc.on.ca. 5. Division of Urology, Department of Surgery, Western University, London, Canada. alp.Sener@lhsc.on.ca. 6. Department of Microbiology and Immunology, Western University, London, Canada. alp.Sener@lhsc.on.ca.
Abstract
INTRODUCTION: Thrombosis of the pancreas after transplantation is the most common cause of relaparotomy and resultant graft loss. There is currently no standard protocol consistently proven to prevent thrombosis following transplantation. Our objective was to determine whether our protocol of post-operative low-dose intravenous (IV) heparin infusion would prevent graft thrombosis without additional complications in our patients. METHODS: A total of 66 simultaneous pancreas kidney (SPK) transplants were performed at our institution from 2004 to 2014. Patients were divided into 2 retrospective cohort groups. Group 1 patients received only acetylsalicylic acid (ASA) 81 mg/d started on post-operative day 1. Group 2 patients received IV heparin infusion beginning in the recovery room at a rate of 500 IU/h for the first 24 hours, reduced by 100 IU/h every day to stop on day 5, and then received ASA 81 mg/d afterward. Outcome and complication rates were compared between the two groups for 5 years post-transplant. RESULTS: We observed a significant reduction in graft thrombosis and graft loss with (0/29) patients in the heparin group vs (7/33) 25.7% from the non-heparin (P<.01) with no differences in complication rates. CONCLUSIONS: We present a heparin infusion protocol which may help prevent graft thrombosis and graft loss in SPK transplantation.
INTRODUCTION:Thrombosis of the pancreas after transplantation is the most common cause of relaparotomy and resultant graft loss. There is currently no standard protocol consistently proven to prevent thrombosis following transplantation. Our objective was to determine whether our protocol of post-operative low-dose intravenous (IV) heparin infusion would prevent graft thrombosis without additional complications in our patients. METHODS: A total of 66 simultaneous pancreas kidney (SPK) transplants were performed at our institution from 2004 to 2014. Patients were divided into 2 retrospective cohort groups. Group 1 patients received only acetylsalicylic acid (ASA) 81 mg/d started on post-operative day 1. Group 2 patients received IV heparin infusion beginning in the recovery room at a rate of 500 IU/h for the first 24 hours, reduced by 100 IU/h every day to stop on day 5, and then received ASA 81 mg/d afterward. Outcome and complication rates were compared between the two groups for 5 years post-transplant. RESULTS: We observed a significant reduction in graft thrombosis and graft loss with (0/29) patients in the heparin group vs (7/33) 25.7% from the non-heparin (P<.01) with no differences in complication rates. CONCLUSIONS: We present a heparin infusion protocol which may help prevent graft thrombosis and graft loss in SPK transplantation.
Authors: A Hakeem; J Chen; S Iype; M R Clatworthy; C J E Watson; E M Godfrey; S Upponi; K Saeb-Parsy Journal: Am J Transplant Date: 2017-09-14 Impact factor: 8.086
Authors: Je Ho Ryu; Tae Beom Lee; Kwang Ho Yang; Taeun Kim; Young Soo Chung; Byunghyun Choi Journal: Ann Transplant Date: 2018-10-02 Impact factor: 1.530