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Early protocol computer tomography and endovascular interventions in pancreas transplantation

Lookup NU author(s): Matt Byrne, Dr Avinash Sewpaul, Dr Sam Tingle, Emily Thompson, Marcus BrookesORCiD, Steven White, Professor Derek Manas, Professor Colin Wilson

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Abstract

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. 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.

Publication metadata

Author(s): Byrne MHV, Battle J, Sewpaul A, Tingle S, Thompson E, Brookes M, Innes A, Turner P, White SA, Manas DM, Wilson CH

Publication type: Article

Publication status: Published

Journal: Clinical Transplantation

Year: 2021

Volume: 35

Issue: 1

Print publication date: 01/01/2021

Online publication date: 22/11/2020

Acceptance date: 02/11/2020

ISSN (print): 0902-0063

ISSN (electronic): 1399-0012

Publisher: John Wiley & Sons Ltd

URL: https://doi.org/10.1111/ctr.14158

DOI: 10.1111/ctr.14158

PubMed id: 33222262

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