Introduction: The complication rate after pancreas transplantation (PTx) is very high, with venous thrombosis being the most commonly occurring complication that leads to early graft loss. There is currently a lack of reliable methods to uncover complications at an early stage. The grafts are in most cases irreversibly damaged, and can only infrequently be saved. In an ongoing study, we investigate whether microdialysis catheters are able to detect complications post PTx. We describe two patients, in which venous thrombi were detected by microdialysis, without any other diagnostic indications.

Method: A 44-year-old male and a 49-year-old female diabetic patient underwent technically similar solitary pancreas transplantations. A common aortic patch with both the coeliac trunk and the superior mesenteric artery was anastomosed “end-to-side” to the common iliac artery on the right side and an elongated portal vein was anastomosed “end-to-side” to the inferior caval vein. At the end of surgery, two microdialysis catheters were placed on the anterior and posterior pancreatic surface. We measured glucose, lactate, pyruvate and glycerol at the bedside, sampled every 1-2 hours postoperatively.

Results:Both patients had uncomplicated initial postoperative courses. On the third postoperative day however, both had elevations in lactate and lactate to pyruvate ratio in microdialysis measurements. Doppler ultrasounds showed well-circulated grafts, but supplemental CT scans revealed venous thrombi in both patients. The female patient underwent immediate angiographic intervention, and the thrombus was successfully removed. The male patient was commenced on high dose dalteparin, but on the seventh postoperative day, another elevation in microdialysis lactate occurred. A control CT showed that the thrombus had increased in size, resulting in immediate angiographic intervention with successful thrombectomy. The patients were discharged on the fourteenth and tenth postoperative day, respectively. They have both had normal control CTs after discharge, and remain insulin-free six months post transplantation.

Conclusion: Monitoring of pancreas transplants with microdialysis catheters appear to detect ischemia at an early stage, and may potentially improve graft survival.

CITATION INFORMATION: Kjosen G, Horneland R, Aandahl E, Oyen O, Tonnessen T, Hakon H. Detection of Venous Thrombi by Microdialysis Catheters and Angiographic Guided Thrombus Extraction in Two Solitary Pancreas Transplants. Am J Transplant. 2016;16 (suppl 3).

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