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Meta-Analysis
. 2023 Feb 1:36:10442.
doi: 10.3389/ti.2023.10442. eCollection 2023.

Heparin Thromboprophylaxis in Simultaneous Pancreas-Kidney Transplantation: A Systematic Review and Meta-Analysis of Observational Studies

Erica Ai Li  1 , Kaveh Farrokhi  1 , Max Y Zhang  2   3 , Juliano Offerni  4   5 , Patrick P Luke  1   3   4   5 , Alp Sener  1   2   3   4   5
Affiliations
Meta-Analysis

Heparin Thromboprophylaxis in Simultaneous Pancreas-Kidney Transplantation: A Systematic Review and Meta-Analysis of Observational Studies

Erica Ai Li et al. Transpl Int. .

Abstract

Thrombosis is a leading causes of pancreas graft loss after simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). There remains no standardized thromboprophylaxis protocol. The aim of this systematic review and meta-analysis is to evaluate the impact of heparin thromboprophylaxis on the incidence of pancreas thrombosis, pancreas graft loss, bleeding, and secondary outcomes in SPK, PAK, and PTA. Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Web of Science® on April 21, 2021. Primary peer-reviewed studies that met inclusion criteria were included. Two methods of quantitative synthesis were performed to account for comparative and non-comparative studies. We included 11 studies, comprising of 1,122 patients in the heparin group and 236 patients in the no-heparin group. When compared to the no-heparin control, prophylactic heparinization significantly decreased the risk of early pancreas thrombosis and pancreas loss for SPK, PAK and PTA without increasing the incidence of bleeding or acute return to the operating room. Heparin thromboprophylaxis yields an approximate two-fold reduction in both pancreas thrombosis and pancreas loss for SPK, PAK and PTA. We report the dosage, frequency, and duration of heparin administration to consolidate the available evidence.

Keywords: heparin; meta-analysis; pancreas transplantation; simultaneous pancreas-kidney transplantation; systematic review; thromboprophylaxis; thrombosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA Flow diagram.
FIGURE 2
FIGURE 2
Forest plots examining the impact of heparin on the (A) incidence of pancreas thrombosis, (B) incidence of pancreas loss due to thrombosis, (C) incidence of postoperative bleeding, (D) incidence of acute return to the OR, (E) mean units of pRBCs transfused.
FIGURE 3
FIGURE 3
Flow diagram of the prophylactic heparin regimens presented in this review. ASA, acetylsalicylic acid; IU, international unit; IV, intravenous; SC, subcutaneous.
See this image and copyright information in PMC

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