Splenic Vein Thrombosis Following Pancreas Transplantation: Identification of Factors That Support Conservative Management

Prophylaxis for graft portal/splenic venous thrombosis following pancreas transplant varies between institutions. Similarly, treatment of venous thrombosis ranges from early re‐exploration to conservative management with anticoagulation. We wished to determine the prevalence of graft splenic vein (S...

Full description

Saved in:
Bibliographic Details
Published in:American journal of transplantation 2017-11, Vol.17 (11), p.2955-2962
Main Authors: Harbell, J. W., Morgan, T., Feldstein, V. A., Roll, G. R., Posselt, A., Kang, S.‐M., Feng, S., Hirose, R., Freise, C. E., Stock, P.
Format: Article
Language:English
Subjects:
Adult
Anticoagulants
Blood clots
clinical research/practice
coagulation and hemostasis
Conservative Treatment
diagnostic techniques and imaging: ultrasound
Doppler effect
Exploration
Female
Follow-Up Studies
Graft Rejection - diagnostic imaging
Graft Rejection - etiology
Graft Rejection - therapy
Graft Survival
Health risk assessment
Heparin
Humans
Insulin
Male
Management
Middle Aged
Pancreas
Pancreas transplantation
Pancreas Transplantation - adverse effects
Pancreas transplants
pancreas/simultaneous pancreas‐kidney transplantation
Postoperative Complications - diagnostic imaging
Postoperative Complications - etiology
Postoperative Complications - therapy
Prognosis
Prophylaxis
Retrospective Studies
Risk Factors
Spleen
Splenic Vein - diagnostic imaging
Splenic Vein - pathology
Thrombosis
thrombosis and thromboembolism
Transplantation
Transplants & implants
Ultrasonography
Ultrasound
Venous Thrombosis - diagnostic imaging
Venous Thrombosis - etiology
Venous Thrombosis - therapy
Warfarin
Citations: Items that this one cites
Items that cite this one
Online Access:Request full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Prophylaxis for graft portal/splenic venous thrombosis following pancreas transplant varies between institutions. Similarly, treatment of venous thrombosis ranges from early re‐exploration to conservative management with anticoagulation. We wished to determine the prevalence of graft splenic vein (SV) thrombosis, as well as the clinical significance of non‐occlusive thrombus observed on routine imaging. Records of 112 pancreas transplant recipients over a 5‐year period at a single center were reviewed. Venous thrombosis was defined as absence of flow or presence of thrombus identified in any part of the graft SV on ultrasound. Thirty patients (27%) had some degree of thrombus or absence of flow in the SV on postoperative ultrasound. There were 5 graft losses in this group. Four were due to venous thrombosis, and occurred within 20 days of transplant. All patients with non‐occlusive partial SV thrombus but normal arterial signal on Doppler ultrasound were successfully treated with IV heparin followed by warfarin for 3–6 months, and remained insulin independent. Findings of arterial signal abnormalities, such as absence or reversal of diastolic flow within the graft, require urgent operative intervention since this finding can be associated with more extensive thrombus that may lead to graft loss. This review of long‐term outcomes of graft venous thrombosis following pancreas transplant identifies imaging and clinical characteristics of nonocclusive thromboses that support conservative management.
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.14428