Skip to main content

Advertisement

SpringerLink
Log in

Effective Technique for Pancreas Transplantation by Iliac Vascular Transposition, Without Heparin-Based Anticoagulation Therapy

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

To evaluate patients undergoing a new procedure, iliac vascular transposition, in pancreas transplantation regarding the risk of thrombosis and graft survival without heparin-based anticoagulation therapy.

Methods

Iliac vascular transposition (IVT) involves changing the positions of the external iliac artery and vein relative to each other. In this study, this technique was evaluated in patients undergoing the procedure compared with patients not undergoing the procedure (iliac vascular parallel (IVP) group).

Results

No patients received prophylactic heparin therapy. Two patients in the IVP group (n = 26) developed complete thrombosis and six developed partial thrombosis, compared with no patients with complete thrombosis and one with partial thrombosis in the IVT group (n = 29). The cumulative incidence of thrombosis was significantly higher in the IVP group (p < 0.01). Cox regression revealed that not receiving iliac vascular transposition was the only significant risk factor for thrombosis (odds ratio: 10.1, 95% confidence interval: 1.27–81.2; p = 0.03). One-year graft survival was significantly better in the IVT group vs IVP group (p = 0.03).

Conclusions

IVT in pancreas transplantation is a simple technique that results in a lower thrombosis risk and better graft survival rates without heparin-based anticoagulation therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. White SA, Shaw JA, Sutherland DE (2009) Pancreas transplantation. Lancet 373:1808–1817. https://doi.org/10.1016/S0140-6736(09)60609-7

    Article  CAS  PubMed  Google Scholar 

  2. Kaku K, Kitada H, Noguchi H et al (2015) Living donor kidney transplantation preceding pancreas transplantation reduces mortality in type 1 diabetics with end-stage renal disease. Transplant Proc 47:733–737. https://doi.org/10.1016/j.transproceed.2014.12.048

    Article  CAS  PubMed  Google Scholar 

  3. Aboalsamh G, Anderson P, Al-Abbassi A et al (2016) Heparin infusion in simultaneous pancreas and kidney transplantation reduces graft thrombosis and improves graft survival. Clin Transplant 30:1002–1009

    Article  CAS  Google Scholar 

  4. Troppmann C (2010) Complications after pancreas transplantation. Curr Opin Organ Transplant 15:112–118

    Article  Google Scholar 

  5. Fertmann JM, Wimmer CD, Arbogast HP et al (2006) Single-shot antithrombin in human pancreas—kidney transplantation: reduction of reperfusion pancreatitis and prevention of graft thrombosis. Transpl Int 19:458–465

    Article  CAS  Google Scholar 

  6. Sollinger HW, Odorico JS, Becker YT et al (2009) One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg 250(4):618–630. https://doi.org/10.1097/SLA.0b013e3181b76d2b

    Article  PubMed  Google Scholar 

  7. Vaidya A, Muthusamy AS, Hadjianastassiou VG et al (2007) Simultaneous pancreas—kidney transplantation: to anticoagulate or not? Is that a question? Clin Transplant 21:554–557

    Article  Google Scholar 

  8. Carr ME (2001) Diabetes mellitus: a hypercoagulable state. J Diabetes Complications 15:44–54

    Article  CAS  Google Scholar 

  9. Schaser KD, Puhl G, Vollmar B et al (2005) In vivo imaging of human pancreatic microcirculation and pancreatic tissue injury in clinical pancreas transplantation. Am J Transplant 5:341–350. https://doi.org/10.1111/j.1600-6143.2004.00663.x

    Article  PubMed  Google Scholar 

  10. Dafoe DC, Ratner LE (2005) Pancreatico-renal composite transplant: a new technique designed to decrease pancreatic graft thrombosis. Clin Transplant 19:690–693

    Article  Google Scholar 

  11. Proneth A, Schnitzbauer AA, Schenker P et al (2018) Extended pancreas donor program-the EXPAND study: a prospective multicenter trial testing the use of pancreas donors older than 50 years. Transplantation 102:1330–1337

    Article  Google Scholar 

  12. Deboudt C, Branchereau J, Luyckx F et al (2012) Pancreas transplantation and venous thrombosis: multivariate analysis of risk factors. Prog Urol 22:402–407. https://doi.org/10.1016/j.purol.2012.01.016 (Epub 2012 Mar 3)

    Article  CAS  PubMed  Google Scholar 

  13. Kopp WH, van Leeuwen CAT, Lam HD et al (2019) Retrospective study on detection, treatment, and clinical outcome of graft thrombosis following pancreas transplantation. Transpl Int 32:410–417. https://doi.org/10.1111/tri.13384 (Epub 2018 Dec 26)

    Article  CAS  PubMed  Google Scholar 

  14. Manrique A, Jiménez C, López RM et al (2009) Relaparotomy after pancreas transplantation: causes and outcomes. Transplant Proc 41:2472–2474

    Article  CAS  Google Scholar 

  15. Okabe Y, Kitada H, Miura Y et al (2013) Pancreas transplantation: a single-institution experience in Japan. Surg Today 43:1406–1411

    Article  Google Scholar 

  16. Molmenti EP, Varkarakis IM, Pinto P et al (2004) Renal transplantation with iliac vein transposition. Transplant Proc 36:2643–2645. https://doi.org/10.1016/j.transproceed.2004.10.012

    Article  CAS  PubMed  Google Scholar 

  17. Ciudin A, Musquera M, Huguet J et al (2012) Transposition of iliac vessels in implantation of right living donor kidneys. Transplant Proc 44:2945–2948. https://doi.org/10.1016/j.transproceed.2012.07.143

    Article  CAS  PubMed  Google Scholar 

  18. Hakeem A, Chen J, Iype S et al (2018) Pancreatic allograft thrombosis: suggestion for a CT grading system and management algorithm. Am J Transplant 18:163–179. https://doi.org/10.1111/ajt.14433 (Epub 2017 Sep 14)

    Article  CAS  PubMed  Google Scholar 

  19. Muthusamy AS, Giangrande PL, Friend PJ (2010) Pancreas allograft thrombosis. Transplantation 90:705–707. https://doi.org/10.1097/TP.0b013e3181eb2ea0

    Article  PubMed  Google Scholar 

  20. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  Google Scholar 

  21. Sutherland DE, Gruessner RW, Dunn DL et al (2001) Lessons learned from more than 1000 pancreas transplants at a single institution. Ann Surg 233:463–501. https://doi.org/10.1097/00000658-200104000-00003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Harbell JW, Morgan T, Feldstein VA et al (2017) Splenic vein thrombosis following pancreas transplantation: identification of factors that support conservative management. Am J Transplant 17:2955–2962. https://doi.org/10.1111/ajt.14428 (Epub 2017 Aug 14)

    Article  CAS  PubMed  Google Scholar 

  23. Raveh Y, Ciancio G, Burke GW et al (2019) Susceptibility-directed anticoagulation after pancreas transplantation: a single-center retrospective study. Clin Transplant 33:e13619. https://doi.org/10.1111/ctr.13619 (Epub 2019 Jun 23)

    Article  CAS  PubMed  Google Scholar 

  24. Jiménez C, Manrique A, Herrero ML et al (2005) Incidence of pancreas graft thrombosis in portoiliac and portocaval venous anastomosis. Transplant Proc 37:3977–3978. https://doi.org/10.1016/j.transproceed.2005.10.081

    Article  PubMed  Google Scholar 

  25. Gonzalez AM, Schraibman V, Linhares MM et al (2007) Selective approach for venous drainage in right iliac vein and cava vein for combined pancreas-kidney transplantation. Transplantation 83:228–230. https://doi.org/10.1097/01.tp.0000245466.45934.46

    Article  PubMed  Google Scholar 

  26. Marambio A, Tuñon JMC, Gómez LMM et al (2018) Intraoperative portal vein flow > 123 mL/min per 100 g predicts a better survival of patients after liver transplantation. Transplant Proc 50:3582–3586. https://doi.org/10.1016/j.transproceed.2018.06.032

    Article  CAS  PubMed  Google Scholar 

  27. Spitzer AL, Dick AA, Bakthavatsalam R et al (2010) Intraoperative portal vein blood flow predicts allograft and patient survival following liver transplantation. HPB 12:166–173. https://doi.org/10.1111/j.1477-2574.2009.00137.x

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank Ms Yasuka Ogawa (Medical Assistant) for data collection. We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript and helping to draft the abstract.

Funding

The authors have no funding to declare.

Author information

Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Keizo Kaku, Yasuhiro Okabe, Yu Sato, Yu Hisadome, Takanori Mei, Hiroshi Noguchi & Masafumi Nakamura

Authors
  1. Keizo Kaku
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuhiro Okabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu Hisadome
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takanori Mei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masafumi Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masafumi Nakamura.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Consent to participate

Written informed consent was obtained from the patients for participation in this study.

Ethics approval

This study was performed in accordance with the guidelines of the Declaration of Helsinki and was approved by the Kyushu University Institutional Review Board for Clinical Research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaku, K., Okabe, Y., Sato, Y. et al. Effective Technique for Pancreas Transplantation by Iliac Vascular Transposition, Without Heparin-Based Anticoagulation Therapy. World J Surg 46, 215–222 (2022). https://doi.org/10.1007/s00268-021-06232-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-021-06232-y

Search

Navigation