Successful surgical salvage of pancreas allografts after complete venous thrombosis

Background. Complete venous thrombosis of the pancreas after simultaneous p ancreas-kidney (SPK) transplantation usually results in graft loss. We desc ribe a technique, that allows salvage of the graft after complete venous th rombosis. Methods. A total of 150 patients with insulin dependent diabetes mellitus/e nd stage renal disease underwent SPK over the past decade at the University of Miami. Of these, three patients developed complete venous thrombosis af ter induction therapy with anti-interleukin-2R antibody and i.v. tacrolimus . These three patients underwent surgical thrombectomy followed by heparini zation and oral anticoagulation, The splenic vein was opened distally at th e tail of the pancreas and the superior mesenteric vein at the level of the mesentery or head of the pancreas. Thrombectomy was performed with a Fogar ty catheter, The portal anastomosis was not opened or manipulated. The arte rial "Y" graft was not clamped and the right iliac vein was controlled prox imally with a double wrapped vessel-loop to contain possible thrombus. In o ne patient, the partially thrombosed splenic artery was opened at the tail of the pancreas and thrombectomy was performed in the same fashion. There w ere no apparent technical problems. A pancreatic biopsy was not performed, nor was acute rejection treated empirically. Results. Intraoperative and serial Doppler ultrasound showed good flow thro ugh the allograft, In all three patients the exocrine and endocrine functio n of the pancreas was preserved with a mean follow-up of 15 months. Conclusions. The described surgical thrombectomy followed by systemic antic oagulation may be useful in the salvage of the allograft pancreas in case o f complete venous thrombosis.