Vascular complications of pancreas transplantation

The purpose of our study was to focus on the early diagnosis and treatment of vascular complications after simultaneous pancreas-kidney (SPK) transplantation. Description of the technique for salvage of the graft after venous thrombosis (VT) is also provided.

From July 1994 to December 2002, 14 patients of 206 SPK transplant recipients had partial VT. Partial splenic VT (PSVT) was documented in 10 patients (4.8%), two had complete thrombosis of the splenic vein, one partial superior mesenteric thrombosis, and one developed partial thrombosis of the splenic and superior mesenteric vein. Four patients developed complete VT of the pancreas allograft and one superior mesenteric artery thrombosis. Our experience with four arteriovenous fistulae is also reported. The immunosuppression included tacrolimus, steroids, and monoclonal antibody to the IL-2 receptor. Thymoglobulin was introduced in June 2000 in our protocol combined with rapamycin or mycophenolate mofetil. These cases were identified following the intravenous (iv) use of tacrolimus with or without anti-IL-2R therapy. One case of complete VT is also reported one month following transplantation in a recipient with high rapamycin levels. Diagnosis was established during routine color Doppler ultrasonography.

Partial VT was effectively treated with anticoagulation. Complete VT required surgical thrombectomy. In our series, the pancreas was salvaged successfully in all patients with the technique described here.

Early diagnosis of vascular complications after pancreas transplantation is of paramount importance for the appropriate treatment with organ salvage. Based on our experience, we suggest that VT can be effectively treated with anticoagulation. Aspirin is sufficient for PSVT.