Antithrombin therapy in pancreas retransplantation and pancreas-after-kidney/pancreas-transplantation-alone patients

• Published in: Clinical transplantation Vol. 25; no. 5; pp. E499 - E508
• Main Authors: Fertmann, Jan M., Arbogast, Helmut P., Illner, Wolf-Dieter, Tarabichi, Anwar, Dieterle, Christoph, Land, Walter, Jauch, Karl-Walter, Hoffmann, Johannes N.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2011
• Subjects: Adult; Aged; antithrombin; Antithrombins - therapeutic use; Case-Control Studies; Female; Follow-Up Studies; graft pancreatitis; Graft Rejection - prevention & control; Humans; ischemia reperfusion injury; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Middle Aged; pancreas after kidney transplantation; pancreas retransplantation; Pancreas Transplantation - adverse effects; Pancreas Transplantation - mortality; pancreas transplantation alone; Pancreatitis - drug therapy; Pancreatitis - etiology; Pancreatitis - mortality; Postoperative Complications; Reoperation; Reperfusion Injury - drug therapy; Reperfusion Injury - etiology; Reperfusion Injury - mortality; Retrospective Studies; solitary pancreas transplantation; Survival Rate; Treatment Outcome; Young Adult
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2011.01472.x

Fertmann JM, Arbogast HP, Illner W‐D, Tarabichi A, Dieterle C, Land W, Jauch K‐W, Hoffmann JN. Antithrombin therapy in pancreas retransplantation and pancreas‐after‐kidney/pancreas‐transplantation‐alone patients.
Clin Transplant 2011: 25: E499–E508. © 2011 John Wiley & Sons A/S. :  Antithrombin (AT) is a coagulatory inhibitor with pleiotropic activities. AT reduces ischemia/reperfusion injury and has been successfully used in patients with simultaneous pancreas kidney transplantation. This study retrospectively analyzes prophylactic high‐dose AT application in patients with solitary pancreas transplantation traditionally related to suboptimal results. In our center, 31 patients received solitary pancreas transplantation between 7/1994 and 7/2005 (pancreas retransplantation, PAK/PTA). The perioperative treatment protocol was modified in 5/2002 now including application of 3000 IU. AT was given intravenously before pancreatic reperfusion (AT, n = 18). Patients receiving standard therapy served as controls (n = 13). Daily blood sampling was performed during five postoperative days. Standard coagulatory parameters and number of transfused red blood cell units were not altered by AT. In AT patients serum amylase (p < 0.01) and lipase (p < 0.01) on postoperative days 1, 2 and 3 were significantly reduced. Our actual perioperative management protocol including high dose AT application in human solitary pancreas transplantation reduced postoperative liberation of pancreatic enzymes in this pilot study. Prophylactic AT application should deserve further clinical testing in a randomized controlled trial.