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. 2020 Jan-Dec:26:1076029620942589.
doi: 10.1177/1076029620942589.

Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review

Jian Blundell  1 , Sara Shahrestani  1   2 , Rebecca Lendzion  2 , Henry J Pleass  1   2 , Wayne J Hawthorne  1   2   3
Affiliations

Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review

Jian Blundell et al. Clin Appl Thromb Hemost. 2020 Jan-Dec.

Abstract

Simultaneous pancreas-kidney (SPK) transplantation remains the most effective treatment for providing consistent and long-term euglycemia in patients having type 1 diabetes with renal failure. Thrombosis of the pancreatic vasculature continues to contribute significantly to early graft failure and loss. We compared the rate of thrombosis to graft loss and systematically reviewed risk factors impacting early thrombosis of the pancreas allograft following SPK transplantation. We searched the MEDLINE, EMBASE, The Cochrane Library, and PREMEDLINE databases for studies reporting thrombosis following pancreas transplantation. Identified publications were screened for inclusion and synthesized into a data extraction sheet. Sixty-three studies satisfied eligibility criteria: 39 cohort studies, 22 conference abstracts, and 2 meta-analyses. Newcastle-Ottawa Scale appraisal of included studies demonstrated cohort studies of low bias risk; 1127 thrombi were identified in 15 936 deceased donor, whole pancreas transplants, conferring a 7.07% overall thrombosis rate. Thrombosis resulted in pancreatic allograft loss in 83.3% of reported cases. This review has established significant associations between donor and recipient characteristics, procurement and preservation methodology, transplantation technique, postoperative management, and increased risk of early thrombosis in the pancreas allograft. Further studies examining the type of organ preservation fluid, prophylactic heparin protocol, and exocrine drainage method and early thrombosis should also be performed.

Keywords: graft loss; pancreas allograft; pancreas transplant; risk factors; simultaneous pancreas-kidney (SPK) transplantation; thrombosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Systematic search algorithm using Ovid. MeSH subject headings are highlighted in bold, and keyword searches in italics. Search terms revolved around pancreas transplant, thrombosis, and risk factors.
Figure 2.
Figure 2.
PRISMA CONSORT diagram showing identification and screening of studies for inclusion in the systematic review. PRISMA CONSORT indicates Preferred Reporting Items for Systematic reviews and Meta-Analyses Consolidated Standards of Reporting Trials.
See this image and copyright information in PMC

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