MP79-13 POST-OPERATIVE INTRAVENOUS HEPARIN INFUSION IMPROVES SHORT AND LONG TERM SIMULTANEOUS KIDNEY-PANCREAS TRANSPLANT OUTCOMES

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-13 POST-OPERATIVE INTRAVENOUS HEPARIN INFUSION IMPROVES SHORT AND LONG TERM SIMULTANEOUS KIDNEY-PANCREAS TRANSPLANT OUTCOMES Patrick Anderson, Ghaleb Aboalsamh, Amira Al Abbassi, Vivian McAlister, Patrick Luke, and Alp Sener Patrick AndersonPatrick Anderson More articles by this author , Ghaleb AboalsamhGhaleb Aboalsamh More articles by this author , Amira Al AbbassiAmira Al Abbassi More articles by this author , Vivian McAlisterVivian McAlister More articles by this author , Patrick LukePatrick Luke More articles by this author , and Alp SenerAlp Sener More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2870AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Simultaneous kidney-pancreas (SPK) transplant remains the most definitive treatment for patients with type-1 diabetes and end-stage renal disease. Despite modern therapeutic strategies, vascular thrombosis of the pancreas after transplantation is the most common cause of re-laparotomy and resultant graft loss. Our objective was to determine whether the administration of a post-operative intravenous heparin infusion would lead to a reduction in graft loss in these patients. METHODS A total of 66 SPK transplants were performed at our institution from 2004 to 2014. Patients were divided into a prospective (Group 1) and retrospective cohort (Group 2). Group 1 patients received intravenous heparin infusion beginning in the recovery room at a rate of 500IU/hour for the first 24 hours, followed by 400IU/hour, 300IU/hour, 200IU/hour, and 100IU/hour on post-operative days 2, 3, 4, and 5 respectively. Group 2 patients did not receive post-operative intravenous heparin infusion. All patients were started on anti-platelet therapy of acetylsalicylic acid (ASA) 81mg/day on post-operative day 6. In addition to donor, recipient and immunosuppression characteristics, we evaluated parameters of short and long-term SPK graft function, serum biochemistries, transfusion and complication rates between the two groups for 5 years post-transplant. RESULTS There were no differences between donor and recipient characteristics including age, gender, BMI, and graft cold and warm ischemia times. There were no significant differences in estimated glomerular filtration rate (eGFR), hemoglobin, serum amylase, serum lipase, hemoglobin A1C, or number of units of packed red blood cells transfused between the groups. However, a difference in complication rates between the groups was found. Nine patients (25.7%) from the non-heparinized cohort suffered from pancreas graft thrombosis resulting in re-laparotomy and loss of allograft compared to 0 patients from the heparin infusion group (P<0.01). Post-operative heparin infusion did not impact overall patient survival up to 5 years post-transplant. CONCLUSIONS We prospectively show, for the first time, that the use of a post-operative low dose intravenous heparin infusion has a protective effect against pancreas graft thrombosis and graft loss in SPK transplants without any effects on transfusion or other complication rates. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1015 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Anderson More articles by this author Ghaleb Aboalsamh More articles by this author Amira Al Abbassi More articles by this author Vivian McAlister More articles by this author Patrick Luke More articles by this author Alp Sener More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...