1. Early detection of complications in pancreas transplants by microdialysis catheters, an observational feasibility study.
- Author
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Kjøsen G, Rydenfelt K, Horneland R, Aandahl EM, Line PD, Dorenberg E, Berstad AE, Brabrand K, Hagen G, Pischke SE, Bergmann GB, Nordheim E, Jenssen TG, Tønnessen TI, and Haugaa H
- Subjects
- Adult, Antilymphocyte Serum therapeutic use, Catheters, Indwelling, Early Diagnosis, Feasibility Studies, Female, Glucose metabolism, Glycerol metabolism, Graft Rejection immunology, Graft Rejection metabolism, Hematoma etiology, Hematoma immunology, Hematoma metabolism, Humans, Immunosuppressive Agents therapeutic use, Lactic Acid metabolism, Male, Microdialysis instrumentation, Middle Aged, Mycophenolic Acid therapeutic use, Pyruvic Acid metabolism, Tacrolimus therapeutic use, Venous Thrombosis etiology, Venous Thrombosis immunology, Venous Thrombosis metabolism, Graft Rejection diagnosis, Hematoma diagnosis, Microdialysis methods, Monitoring, Physiologic methods, Pancreas Transplantation adverse effects, Venous Thrombosis diagnosis
- Abstract
Background: Despite advances in immunosuppression and surgical technique, pancreas transplantation is encumbered with a high rate of complication and graft losses. Particularly, venous graft thrombi occur relatively frequently and are rarely detected before the transplant is irreversibly damaged., Methods: To detect complications early, when the grafts are potentially salvageable, we placed microdialysis catheters anteriorly and posteriorly to the graft in a cohort of 34 consecutive patients. Glucose, lactate, pyruvate, and glycerol were measured at the bedside every 1-2 hours., Results: Nine patients with graft venous thrombosis had significant lactate and lactate-to-pyruvate-ratio increases without concomitant rise in blood glucose or clinical symptoms. The median lactate in these patients was significantly higher in both catheters compared to non-events (n = 15). Out of the nine thrombi, four grafts underwent successful angiographic extraction, one did not require intervention and four grafts were irreversibly damaged and explanted. Four patients with enteric anastomosis leakages had significantly higher glycerol measurements compared to non-events. As with the venous thrombi, lactate and lactate-to-pyruvate ratio were also increased in six patients with graft surrounding hematomas., Conclusions: Bedside monitoring with microdialysis catheters is a promising surveillance modality of pancreatic grafts, but differentiating between the various pathologies proves challenging., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
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