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The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation

INTRODUCTION: Simultaneous kidney and pancreas transplant is the preferred treatment option for end-stage renal disease due to type 1 diabetic nephropathy. Vascular complications are detrimental to graft survival and can lead to graft loss in the early postoperative phase of transplantation. General...

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Autores principales: Shahbazov, Rauf, Azari, Feredun, Whan, Park Auh, Wei, Liu, Agarwal, Avinash, Brayman, Kenneth L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000769/
https://www.ncbi.nlm.nih.gov/pubmed/29604531
http://dx.doi.org/10.1016/j.ijscr.2018.03.014
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author Shahbazov, Rauf
Azari, Feredun
Whan, Park Auh
Wei, Liu
Agarwal, Avinash
Brayman, Kenneth L.
author_facet Shahbazov, Rauf
Azari, Feredun
Whan, Park Auh
Wei, Liu
Agarwal, Avinash
Brayman, Kenneth L.
author_sort Shahbazov, Rauf
collection PubMed
description INTRODUCTION: Simultaneous kidney and pancreas transplant is the preferred treatment option for end-stage renal disease due to type 1 diabetic nephropathy. Vascular complications are detrimental to graft survival and can lead to graft loss in the early postoperative phase of transplantation. Generally, duplex Doppler ultrasound is used for vascular patency monitoring and pancreatectomy followed by re-transplantation is required in the majority of cases. Recently, pancreatic graft salvage with non-operative management, including medical anticoagulation and endovascular thrombectomy, in the early postoperative period has been described with success. PRESENTATION OF CASE: We report a case of early detection of pancreas venous graft thrombosis via clinical suspicion and radiological methods, and early intervention with endovascular thrombolysis. As a result, the pancreatic graft was successfully salvaged. DISCUSSION: A limited number of studies had showed successful graft salvage in only 30–45% of thrombosed pancreatic graft with surgical thrombectomy. Our patient also had bleeding from the vascular access site and ultimately required blood transfusion, however she recovered well after procedure. CONCLUSION: Given the complexity and significance of PVGT, urgent and prompt treatment is necessary. Interpreting outcomes from our case and other small studies, it appears that endovascular pharmacomechanical thrombectomy can be a vital tool to salvage graft organs in those receiving SPK.
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spelling pubmed-60007692018-06-15 The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation Shahbazov, Rauf Azari, Feredun Whan, Park Auh Wei, Liu Agarwal, Avinash Brayman, Kenneth L. Int J Surg Case Rep Case Report INTRODUCTION: Simultaneous kidney and pancreas transplant is the preferred treatment option for end-stage renal disease due to type 1 diabetic nephropathy. Vascular complications are detrimental to graft survival and can lead to graft loss in the early postoperative phase of transplantation. Generally, duplex Doppler ultrasound is used for vascular patency monitoring and pancreatectomy followed by re-transplantation is required in the majority of cases. Recently, pancreatic graft salvage with non-operative management, including medical anticoagulation and endovascular thrombectomy, in the early postoperative period has been described with success. PRESENTATION OF CASE: We report a case of early detection of pancreas venous graft thrombosis via clinical suspicion and radiological methods, and early intervention with endovascular thrombolysis. As a result, the pancreatic graft was successfully salvaged. DISCUSSION: A limited number of studies had showed successful graft salvage in only 30–45% of thrombosed pancreatic graft with surgical thrombectomy. Our patient also had bleeding from the vascular access site and ultimately required blood transfusion, however she recovered well after procedure. CONCLUSION: Given the complexity and significance of PVGT, urgent and prompt treatment is necessary. Interpreting outcomes from our case and other small studies, it appears that endovascular pharmacomechanical thrombectomy can be a vital tool to salvage graft organs in those receiving SPK. Elsevier 2018-03-16 /pmc/articles/PMC6000769/ /pubmed/29604531 http://dx.doi.org/10.1016/j.ijscr.2018.03.014 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Shahbazov, Rauf
Azari, Feredun
Whan, Park Auh
Wei, Liu
Agarwal, Avinash
Brayman, Kenneth L.
The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation
title The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation
title_full The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation
title_fullStr The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation
title_full_unstemmed The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation
title_short The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation
title_sort successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000769/
https://www.ncbi.nlm.nih.gov/pubmed/29604531
http://dx.doi.org/10.1016/j.ijscr.2018.03.014
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