Use of extended criteria donor organs is a risk factor for pancreas graft thrombosis

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C.A.T. van Leeuwen, W.H. Kopp, H. de Kort, H.J.W. de Fijter, H. Putter, A.G. Baranski, A.F.M. Schaapherder, J. Ringers, A.E. Braat

Chair(s): dr. Robert A. Pol, vaat-en transplantatiechirurg, UMC Groningen & dr. Wojaiech G. Polak, chirurg, Erasmus MC

Thursday 10 march 2016

9:10 - 9:20h at Zaal 5 & 6

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie VIII - Klinisch chirurgisch en acuut

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Introduction: 
Despite improvements in perioperative management of pancreas transplantation recipients, graft thrombosis remains a serious threat. Scarcity of organs forces transplant professionals to accept more extended criteria organs. This use of high-risk organs might lead to an increased number of graft thrombosis. Furthermore, in the literature the association of graft thrombosis with antibody mediated rejection (AMR) has been described.

Methods: 
All consecutive pancreas transplantation performed from 2004 until 2014 were analysed. Primary endpoint was the incidence of graft thrombosis within 90 days after transplantation. Influence of donor risk was analysed. Secondary endpoints were bleeding and reoperation. Thrombosis due to proven AMR was not considered thrombosis. AMR was defined as C4d positivity on histological examination and present donor specific antibodies (DSA). Suspicion of AMR was defined as positive C4d or DSA.

Results: 
211 consecutive pancreas transplantations were performed (185 SPK, 24 PAK, 2 PTA). Mean pancreas donor risk index (PDRI) was 1.36 (SD 0.44). Two female recipients had thrombosis due to AMR. Complete graft thrombosis occurred in 15/211 cases (7.1%). In 53/211 patients (25.1%) a reoperation had to be performed, this was in 15/53 cases (28.3%) for bleeding. Graft thrombosis risk was 2.3% for standard criteria donors and 10.6% for extended criteria donors (p=0.028). Multivariate analysis showed that an extended criteria donor pancreas is an independent risk factor for graft thrombosis (HR 4.7, p=0.042) and also, female recipients were at increased risk (HR 3.9, p=0.021). AMR was suspected (not proven) in 0/4 male recipients and 4/10 female recipients (p=0.251).

Conclusion: 
Graft thrombosis is the main cause of early graft failure, however, for standard criteria donors, the risk of thrombosis is low (2.3%). Extended criteria donors have an increased risk for graft thrombosis. Risk of thrombosis is also higher in female recipients, possibly explained by the higher prevalence of suspected AMR.