Due to convenient application, novel oral anticoagulants (NOAC), although not registered for renal failure, are an attractive therapeutic option. They are even more tempting in patients with heparin induced thrombocytopenia (HIT). A 36-year old woman with a 25-year history of diabetes, on dialysis therapy for 16 months was enlisted for simultaneous pancreas-kidney transplantation. When RRT was begun, she suffered from deep vein thrombosis and was diagnosed with HIT. She was given fondaparinux during dialysis and put on off-label dabigatran, but the information never made it to the waiting list. On arrival her thrombin time was undeterminable, but after checking the availability of idarucizumab, the decision to proceed with transplantation was made. When renal transplant was performed to the left iliac fossa and no major bleeding occurred, the pancreas was transplanted do the VCI and iliac artery, with enteric drainage of pancreatic juice. With immediate function of both grafts, her thrombin time returned to normal ~120 hours after last dose of dabigatran and prophylaxis with fondaparinux was started, substituted with warfarin from day 17. In her post-op course, the patient needed a transfusion of 2 packs of red cells 24 hours after the procedure. We conclude that organ transplantation, including pancreas, can be safely done on NOAC therapy. Although the risk of graft thrombosis must be considered, pancreas transplant is an option in patients with HIT.

CITATION INFORMATION: Lisik W, Jozwik A, Czerwinski J, Gorski L, Kosieradzki M. Simultaneous Pancreas-Kidney Transplantation Can Be Safely Done on Dabigatran Therapy. Am J Transplant. 2017;17 (suppl 3).

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