*Purpose: Despite technical refinements, early pancreas graft loss due to thrombosis continues to occur. Conventional coagulation tests do not detect hypercoagulability and hence is left untreated. Thromboelastogram (TEG) is a dynamic, in-vitro diagnostic test that provides a global hemostatic profile. This study compares the outcome between TEG and conventional tests-based anticoagulation in SPK recipients.

*Methods: We compared the outcomes of 17 SPK recipients who received TEG directed anticoagulation (TEG-SPK) against 51 contemporaneous SPK recipients matched for donor age and graft type (DBD/DCD), who received clinically directed anticoagulation (Clinical-SPK). Anticoagulation consisted of IV heparin titrated up to 500IU/hour based on clinical assessment or directed by TEG results. Thrombotic graft loss, bleeding complications, radiological incidence of thrombus, thrombus resolution rate after anticoagulation escalation and proportion of patients needing blood transfusion between the two groups were compared.

*Results: There were 16/68 DCD grafts (4 TEG-SPK and 12Clinical-SPK). No graft loss in TEG-SPK group, whereas 12 grafts (8pancreas, 4 kidneys) were lost due to thrombosis in Clinical-SPK group. (p=0.0372/ fisher’s exact test). Overall clinical incidence of post-operative bleeding (hematoma/GI bleeding/hematuria/re-exploration for bleeding without any bleeding source) was 17.65% [3/17] (TEG-SPK) and 45.10% [23/51] (Clinical-SPK), p=0.0499, fisher’s exact test. Incidence of radiologically confirmed partial graft thrombosis was 41.18% in TEG and 23.53% in Clinical-SPK group, p=0.1602, chi square test. All recipients with thrombus had anticoagulation dose escalation. Thrombus resolution rates in subsequent scans, in TEG-SPK and Clinical-SPK groups were 85.71% and 66.67% respectively, p=0.3631, chi square test. The proportion of patients requiring transfusion was 17.65% in TEG group vs 39.25% in Clinical SPK group, p=0.314, fisher’s exact test.

*Conclusions: TEG is a promising tool in guiding judicious use of anticoagulation with less bleeding risk and concomitant prevention of graft loss due to thrombosis.

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