Early protocol computer tomography and endovascular interventions in pancreas transplantation

Background Early vascular complications following pancreatic transplantation are not uncommon (3%–8%). Typically, cross‐sectional imaging is requested in response to clinical change. We instituted a change in protocol to request imaging pre‐emptively to identify patients with thrombotic complication...

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Bibliographic Details
Published in:Clinical transplantation 2021-01, Vol.35 (1), p.e14158-n/a
Main Authors: Byrne, Matthew H. V., Battle, Joseph, Sewpaul, Avinash, Tingle, Samuel, Thompson, Emily, Brookes, Marcus, Innes, Ailsa, Turner, Paul, White, Steven A., Manas, Derek M., Wilson, Colin H.
Format: Article
Language:English
Subjects:
arterial thrombosis
computer tomography
endovascular procedure
Graft Survival
Humans
pancreas transplantation
Pancreas Transplantation - adverse effects
Retrospective Studies
thrombectomy
Tomography, X-Ray Computed
vascular graft
venous thrombosis
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Summary:Background Early vascular complications following pancreatic transplantation are not uncommon (3%–8%). Typically, cross‐sectional imaging is requested in response to clinical change. We instituted a change in protocol to request imaging pre‐emptively to identify patients with thrombotic complications. Methods In 2013, protocol computer tomography angiography (CTA) at days 3–5 and day 10 following pancreas transplantation was introduced. A retrospective analysis of all pancreas transplants performed at our institution from January 2001 to May 2019 was undertaken. Results A total of 115 patients received pancreas transplants during this time period. A total of 78 received pancreas transplant without routine CTA and 37 patients with the new protocol. Following the change in protocol, we detected a high number of subclinical thromboses (41.7%). There was a significant decrease in invasive intervention for thrombosis (78.6% before vs 30.8% after, p = .02), and graft survival was significantly higher (61.5% before vs 86.1% after, p = .04). There was also a significant reduction in the number of graft failures (all‐cause) where thrombosis was present (23.4% before vs 5.6% after, p = .02). Patient survival was unaffected (p = .48). Conclusions Implementation of early protocol CTA identifies a large number of patients with subclinical graft thromboses that are more amenable to conservative management and significantly reduces the requirement for invasive intervention.
ISSN:0902-0063
1399-0012
DOI:10.1111/ctr.14158