Management of Pancreas Graft Splenic Vein Thrombosis: Is Conservative Management Safe?

J. Harbell,¹ T. Morgan,² V. Feldstein,² G. Roll,¹ A. Posselt,¹ S.-M. Kang,¹ S. Feng,¹ R. Hirose,¹ C. Freise,¹ P. Stock.¹

¹Surgery, University of California, San Francisco, San Francisco, CA
²Radiology, University of California, San Francisco, San Francisco, CA.

Meeting: 2015 American Transplant Congress

Abstract number: C187

Keywords: Graft function, Graft survival, Kidney/pancreas transplantation, Pancreas transplantation

Session Information

Session Name: Poster Session C: More Controversies in Pancreas Transplantation

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Background: 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.

Methods: Records of 112 pancreas transplant recipients from January 1st, 2008 to December 31st, 2012 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.

Results: Thirty patients (27%) had some degree of thrombus or absence of flow in the SV on post-operative ultrasound. There were 4 graft losses in this group. All were due to arterial and venous thrombosis, and all occurred within 20 days of transplant. All patients with 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. Treatment with therapeutic IV unfractionated heparin in patients with partial SV thrombus did not significantly increase the need for transfusion (OR 0.70, 95% CI 0.30-1.7, p=0.52) or risk of gastrointestinal bleeding (OR 1.42, 95% CI 0.40-5.1, p = 0.73). However, there was a higher rate of re-operation for bleeding in the group with partial SV thrombus, which did not reach statistical significance (OR 2.9, 95% CI 0.56-15.4, p = 0.34).

Conclusion: Non-occlusive SV thrombus of the pancreas graft can be managed safely with anticoagulation alone. Ultrasound findings that include arterial signal abnormalities, such as absent or reversal of diastolic flow, warrant emergent operative exploration. Therapeutic anticoagulation with antiplatelet agents in addition to intravenous low molecular weight heparin does not significantly increase the risk of bleeding complications in this patient population.

To cite this abstract in AMA style:

Harbell J, Morgan T, Feldstein V, Roll G, Posselt A, Kang S-M, Feng S, Hirose R, Freise C, Stock P. Management of Pancreas Graft Splenic Vein Thrombosis: Is Conservative Management Safe? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/management-of-pancreas-graft-splenic-vein-thrombosis-is-conservative-management-safe/. Accessed November 21, 2024.

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