Session Time: 3:15pm-4:45pm
Presentation Time: 4:27pm-4:39pm
*Purpose: The aim of this study is to evaluate US doppler flow dynamics following total pancreatectomy and autologous islet cell transplant (TPAIT) and establish any correlation with the liver function tests, islet cell mass, and bleeding or portal vein thrombosis (PVT) outcomes.
*Methods: Retrospective analysis of prospectively collected data was done at a single institution from February 2018 to September 2019. Doppler ultrasonography (US) measuring individual major portal vein (PV) branch velocity (PVV) was performed on post-operative day (POD) 1, 2, and 5, and as applicable due to abnormal liver function tests (LFT). All patients received anticoagulation per protocol. Pearson’s correlation analysis of PVV and LFTs, islet cell volume, and islet cell mass was performed.
*Results: During the study period, 14 cases of TPAIT were performed. The mean change in PV pressure at infusion was 5.4 cm H2O (range 1.5-26, SD 6.3). LFTs peaked on POD 2. The lowest mean flow was observed on POD 1 in the main and right posterior PV and on POD 2 in the right anterior and left PV. Correlation analysis found a very weak correlation between LFTs and PVV that was not statistically significant until POD 5 (r = 0.55, p = 0.04). In the post-discharge period, the correlation between LFTs and PVV was strong and statistically significant (r = 1.0, p < 0.001). There was a strong negative correlation between islet cell volume infused and right anterior PVV on POD 2 (r = -0.88, p = 0.02). Islet cell mass and PVV did not significantly correlate until POD 5 (r = 0.80, p = 0.03). No patients had PVT. Two patients had post-operative bleeding, both of which had extremely low velocities (main PVV 0.181).
*Conclusions: In this study, we found that the correlation between PVV and LFTs was weak in the immediate post-operative period, and did not become significant until the post-discharge period when doppler ultrasonography was performed due to clinical concern rather than protocol. The value of scheduled post-operative velocity measurement in relation to PVT evaluation may be overstated. Repeated doppler ultrasonography may be anxiety provoking and lead to supratherapeutic anticoagulation, which could result in bleeding.
To cite this abstract in AMA style:Williams BM, Baldwin X, Vonderau JS, Desai CS. Evaluation of US Doppler Examination of Portal Flow Dynamics in Patients with Total Pancreatectomy and Autologous Islet Cell Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-us-doppler-examination-of-portal-flow-dynamics-in-patients-with-total-pancreatectomy-and-autologous-islet-cell-transplant/. Accessed September 29, 2020.
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