A successful simultaneous pancreas-kidney (SPK) transplant in recipients with end-stage diabetic nephropathy will provide normoglycemia and exert a salutary effect on neurovascular complications. Early, non-technical thrombosis is the main cause of pancreas allograft loss.

The objective of our study was to identify factors associated with pancreas graft thrombosis.

An analysis of variables (donor, recipient, post-operative) was carried out on 71 SPK transplants performed from 2005-2015 to identify correlates of graft thrombosis. The database was composed of Era 1 (n=46) and Era 2 (n=25) defined by a distinct change in protocol. The Era 2 protocol entailed less aggressive fluid replacement (not driven by a CVP target of 10-12) and a single intraoperative loading dose of heparin.

The primary outcome evaluated was pancreas graft thrombosis at 30 days.

The following variables were associated with pancreas graft thrombosis as compared to surviving grafts: net intake and output (I&O) during surgery (mean 7,500 vs. 4,169 cc, P=0.0001) and net I&O in the first 24 hours (10,700 vs. 7,136 cc, P=0.003) and need for vasopressors (P=0.034). Heparin administration (P=0.009) correlated with freedom from thrombosis and the addition of aspirin nearly achieved significance, (P=0.056). The number of thromboses differed significantly in Era 1 (8/46) vs. Era 2 (0/25), P=0.044. Our latest SRTR report showed 100% 1 year patient and kidney graft survival with no Era 2 pancreas graft losses.

Conclusions: Judicious perioperative fluid replacement, avoidance of vasopressors and a single dose of heparin appeared to be protective against pancreas graft thrombosis.

CITATION INFORMATION: Steggerda J, Bornhurst K, Annamalai A, Peng A, Mirocha J, Dafoe D. An Analysis of Factors Associated with Pancreas Allograft Thrombosis. Am J Transplant. 2016;16 (suppl 3).

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