Pancreas Transplantation in a Single Center: Risk Factors Associated With Pancreatic Allograft Thrombosis

Abstract

Pancreas transplantation remains a challenging procedure for small and medium-sized transplants teams, despite improvements in graft survival. Data regarding the impact of the procurement team's experience on the outcomes of pancreas transplant are lacking. The objective of this study was to evaluate risk factors that lead to pancreatic allograft thrombosis, especially the experience of the pancreas procurement team. A retrospective study of 137 patients who underwent pancreas transplantation between March 2005 and May 2017 was conducted. Donor's and recipient characteristics were evaluated as well as their relationship to pancreatic allograft thrombosis. Cases were divided according to the number of pancreas procurements previously done by the procurement surgeon: group 1 (30 to 40 retrievals) and group 2 (≥40 retrievals). Simultaneous pancreas-kidney transplants accounted for 89.8% of cases (n=123). Surgeons from group 2 performed 62.8% (n=86) of the procurements. The graft was removed in 19 cases (13.8%) due to thrombosis. In univariate analysis, lower experience of the retrieval team was associated with allograft loss (P=.04). In multivariate analysis, donor intensive care unit time ≥5 days (P=.03) and lower experience of the procurement team were associated with increased risk of pancreatic allograft thrombosis (P=.02), whereas recipient's age from 30 to 40 years (P=.018) or ≥40 years (P=.02) was found as a protective factor. Pancreatic allograft thrombosis remains an important cause of graft loss in pancreas transplantation. Recipient's age, prolonged donor intensive care unit time, and lower experience of the procurement team directly influence pancreatic allograft thrombosis.