The venous thrombosis of the pancreatic graft

Venous thrombosis of the pancreatic graft is the main nonimmunological cause of the loss of transplants. It has a frequency between 0.8 to 20% according to literature. In this study our team tried to identify the risk factors related to the donor, the recipient including the surgical techniques involved.

The study was conducted in the Department of Transplant Surgery, University Hospital Strasbourg-Hautepierre. 37 patients, with type I diabetes who had been submitted to 7 transplantations of segmentary pancreas and 30 of total pancreas and kidney during 09.07.1992 and 14.08.2006 were included in the study. The surgery comprised the retroperitoneal placement of the pancreas and kidney and the anastomosis with the urinary bladder.

In the immediate evolution we observed 4 thromboses (10.5%). All 4 thromboses were in the group of kidney and total pancreas transplantations. Two of these 4 patients were retransplanted and presented recurrence of thrombosis at 17 days and 1 year.

To prevent thrombosis, it is necessary to perform surgery which avoids unnecessary handling and which ensures broad, tension free vascular anastomoses. The method of early monitoring by pulsed Doppler related to the biological data and the clinical state are suggestive to diagnose thrombosis. The venous thrombosis of the graft implies pancreatic explantation. Retransplantation in patients who have undergone thrombosis of the graft is possible only in well selected patients.