Deceased Donor Issues (Videos Available)

Monday July 02, 2018 from 09:45 to 11:15

Room: N-103

317.1 Extended case series investigating vascular remodelling following whole pancreas transplantation

John Moir, United Kingdom

Institute of Transplantation
Freeman Hospital

Abstract

Extended Case Series Investigating Vascular Remodelling following Whole Pancreas Transplantation

John Moir1, Samantha Saikia2, Rodrigo Figureido1, Adi Kanwar1, John Scott2, Derek Manas1, Colin Wilson1, Steve White1.

1Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; 2Department of Radiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom

Introduction: Vascular remodelling describes the process of luminal narrowing through both physiological and pathological processes. Transplant vasculopathy, with associated remodelling, has typically been attributed to the inflammatory effect of graft rejection, however a number of other non-immunological mechanisms may be at play. This study examined the incidence, potential aetiology and clinical impact of vascular remodelling following combined kidney and pancreas transplantation.
Materials and Methods: After a protocol change in 2012 CT angiography became routine for pancreas transplants in the early (<5 days) and late (< 6 months) post-transplant period. This study examined changes in axial/coronal diameters of the conduit, external iliac artery (EIA), internal iliac artery (IIA), superior mesenteric artery (SMA), splenic artery (SA) and renal arteries. Measurements were made by experienced radiologists.
Results and Discussion: 24 transplants were performed (20 SPK, 3 PAK, 1 PTA) over a 40 month period. All patients received standard immunosuppression of tacrolimus, MMF +/- prednisolone. Significant uniform luminal narrowing was observed in all vessels except the renal arteries.
This observation occurred regardless of the development of de novo DSAs. 4 patients were diagnosed with acute pancreatic graft rejection that resolved with steroids. Imaging demonstrated arterial branch thrombosis in 9 patients. All patients were insulin independent with functioning grafts at a median follow up of 24 months (range 7-51).
Conclusion: Luminal narrowing occurs in pancreatic graft vasculature, with sparing of the renal vessels, and this does not appear to impact on morbidity or short term graft function. Our data suggests mechanisms associated with atherosclerosis, host-donor response or rejection seem unlikely, although an association with a “low grade” chronic rejection causing transplant vasculopathy is plausible. Alternatively this may be due to physiological compensatory change due to altered haemodynamics. Further long-term studies may determine the true clinical impact and need for anti-angiogenic therapeutic intervention.



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