POSSIBLE INVOLVEMENT OF VON-WILLEBRAND-FACTOR IN PANCREATIC GRAFT THROMBOSIS AFTER KIDNEY-PANCREAS TRANSPLANTATION - A RETROSPECTIVE STUDY

Early postoperative graft thrombosis remains the second cause of failu re in pancreas transplantation. Thus, the aim of this study was to com pare retrospectively coagulation and fibrinolysis in type I diabetic r ecipients of simultaneous kidney-pancreas transplants having or not ex perienced thrombosis of their pancreatic graft. From December 1990 to August 1996, 30 simultaneous kidney-pancreas transplants were performe d in 30 uremic type I diabetic patients. Acute thrombosis of the pancr eatic graft was observed among 6 patients (group A), whereas 24 did no t develop thrombosis (group B) although 4 died from other causes. The control groups were composed of kidney transplant (group C) or haemodi alysed (group D) non-diabetic patients, type I diabetics with HbA1C < 8% (group E) or greater than or equal to 8% (group F) who were not in end-stage renal failure and kidney. transplant type I diabetic patient s (group G). Beginning at least 6 months after transplantation, we ana lysed hemostatic factors (fibrinogen, thrombin, and prothrombin times) , coagulation inhibitors (proteins C and S), fibrinolysis (plasminogen activator inhibitor) and endothelial cell abnormalities (Von Willebra nd factor: VWf). Micro and macrovascular complications were evaluated on a score ranging from 0 to 12. Hemostatic factors, coagulation inhib itors and fibrinolysis were similar in groups A and B whereas VWf diff ered significantly in group A (3.49 +/- 0.93 IU/ml) as compared to gro up B (2.04 +/- 0.92 IU/ml) (p < 0.05). VWf was also significantly incr eased in group A relative to the control groups C, D, E, F, and G. The score of vascular complications was increased in groups A and B and s ignificantly higher in group A (9 +/- 0.81 vs. 6.07 +/- 1.75) (p < 0.0 1), while a correlation (r = 0.812, p > 0.05) was observed between VWf levels and the severity of vascular complications. These results poin t out the possible involvement of VWf in the pathogenesis of pancreati c vein thrombosis in kidney-pancreas transplantation.