Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm.

Area of Science:

• Transplantation immunology
• Radiology
• Vascular surgery

Background:

• Pancreatic allograft thrombosis (PAT) is the primary cause of nonimmunologic graft failure.
• Accurate grading and risk stratification are crucial for managing PAT.

Purpose of the Study:

• To develop and validate a novel computed tomography (CT) grading system for pancreatic allograft thrombosis (PAT).
• To identify risk factors associated with allograft loss due to PAT.
• To propose a management algorithm for PAT based on CT findings.

Main Methods:

• Retrospective review of 103 consecutive pancreatic transplantations (2009-2014).
• Development of a 4-grade CT scoring system (0-3) for PAT severity.
• Multivariate analysis to identify risk factors for PAT and allograft loss.

Main Results:

• Twenty-four percent of recipients developed PAT; 2.9% experienced graft loss due to portal vein thrombosis.
• Risk factors for PAT included pancreas after simultaneous pancreas-kidney/solitary pancreatic transplantation, acute rejection, and peripancreatic edema on CT.
• No significant difference in outcomes for grade 1 or 2 thrombosis with or without anticoagulation.

Conclusions:

• The proposed CT grading system aids in identifying PAT risk factors and guides clinical decision-making.
• Therapeutic anticoagulation may not be required for low-grade arterial (grade 1-2) and venous (grade 1) PAT.
• Standardized reporting of PAT using this grading system can facilitate future research.