Immediate Retransplantation for Pancreas Allograft Thrombosis

• Published in: American journal of transplantation Vol. 9; no. 4; pp. 740 - 745
• Main Authors: Hollinger, E. F., Powelson, J. A., Mangus, R. S., Kazimi, M. M., Taber, T. E., Goble, M. L., Fridell, J. A.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.04.2009; Wiley
• Subjects: Adult; Biological and medical sciences; Female; Graft failure; Graft Survival; graft thrombosis; Humans; Male; Medical sciences; Middle Aged; pancreas thrombosis; pancreas transplantation; Pancreas Transplantation - mortality; Pancreas Transplantation - pathology; Pancreas Transplantation - physiology; Pancreatectomy; Postoperative Complications - surgery; Reoperation - mortality; Reoperation - statistics & numerical data; retransplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Survivors; Thrombosis - pathology; Thrombosis - surgery; Time Factors; Transplantation, Homologous - pathology; Transplantation, Homologous - physiology; Treatment Failure; Reoperation; retransplantation; Cardiovascular disease; Transplantation; pancreas transplantation; Homotransplantation; Thrombosis; Graft failure; Vascular disease; graft thrombosis; Treatment; Surgery; pancreas thrombosis; Graft; Pancreas
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2009.02517.x

Early pancreas allograft failure most commonly results from thrombosis and requires immediate allograft pancreatectomy. Optimal timing for retransplantation remains undefined. Immediate retransplantation facilitates reuse of the same anatomic site before extensive adhesions have formed. Some studies suggest that early retransplantation is associated with a higher incidence of graft loss. This study is a retrospective review of immediate pancreas retransplants performed at a single center. All cases of pancreas allograft loss within 2 weeks were examined. Of 228 pancreas transplants, 12 grafts were lost within 2 weeks of surgery. Eleven of these underwent allograft pancreatectomy for thrombosis. One suffered anoxic brain injury and was not a retransplantation candidate, one was retransplanted at 3.5 months and nine patients underwent retransplantation 1–16 days following the original transplant. Of the nine early retransplants, one pancreas was lost to heparin‐induced thrombocytopenia, one recipient died with function at 2.9 years and the other grafts continue to function at 76–1137 days (mean 572 days). One‐year graft survival for early retransplantation was 89% compared to 91% for all pancreas transplants at our center. Immediate retransplantation following pancreatic graft thrombosis restores durable allograft function with outcomes comparable to first‐time pancreas transplantation. Immediate retransplantation following pancreatic graft thrombosis restores durable allograft function with outcomes comparable to first‐time pancreas transplantation.