Portal Vein Thrombosis Is a Potentially Preventable Complication in Clinical Islet Transplantation

被引：76

作者：

Kawahara, T. ^{[1
]}

Kin, T. ^{[1
]}

Kashkoush, S. ^{[1
]}

Gala-Lopez, B. ^{[1
]}

Bigam, D. L. ^{[1
]}

Kneteman, N. M. ^{[1
]}

Koh, A. ^{[2
]}

Senior, P. A. ^{[2
]}

Shapiro, A. M. J. ^{[1
]}

机构：

[1] Univ Alberta, Dept Surg, Edmonton, AB, Canada

[2] Univ Alberta, Dept Med, Edmonton, AB, Canada

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2011年 / 11卷 / 12期

基金：

加拿大健康研究院;

关键词：

Islet transplantation; portal vein thrombosis; risk factors; standard liver volume; SINGLE-DONOR; INSULIN INDEPENDENCE; DIABETES-MELLITUS; PANCREATIC-ISLETS; HYPERTENSION;

D O I：

10.1111/j.1600-6143.2011.03717.x

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Percutaneous transhepatic portal access avoids surgery but is rarely associated with bleeding or portal venous thrombosis (PVT). We herein report our large, single-center experience of percutaneous islet implantation and evaluate risk factors of PVT and graft function. Prospective data were collected on 268 intraportal islet transplants (122 subjects). A portal venous Doppler ultrasound was obtained on Days 1 and 7 posttransplant. Therapeutic heparinization, complete ablation of the portal catheter tract with Avitene paste and limiting packed cell volume (PCV) to <5 mL completely prevented any portal thrombosis in the most recent 101 islet transplant procedures over the past 5 years. In the previous cumulative experience, partial thrombosis did not affect islet function. Standard liver volume correlated negatively (r =-0.257, p < 0.001) and PCV correlated positively with portal pressure rise (r = 0.463, p < 0.001). Overall, partial portal thrombosis occurred after 10 procedures (overall incidence 3.7%, most recent 101 patient incidence 0%). There were no cases of complete thrombosis and no patient developed sequelae of portal hypertension. In conclusion, portal thrombosis is a preventable complication in clinical islet transplantation, provided therapeutic anticoagulation is maintained and PCV is limited to <5 mL.

引用

页码：2700 / 2707

页数：8