1. The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis
- Author
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Christophe Masset, Julien Branchereau, Fanny Buron, Georges Karam, Maud Rabeyrin, Karine Renaudin, Florent Le Borgne, Lionel Badet, Xavier Matillon, Christophe Legendre, Denis Glotz, Corinne Antoine, Magali Giral, Jacques Dantal, Diego Cantarovich, DIVAT Consortium, Maria Brunet, Rémi Cahen, Ricardo Codas, Sameh Daoud, Valérie Dubois, Coralie Fournie, Arnaud Grégoire, Alice Koenig, Charlène Lévi, Emmanuel Morelon, Claire Pouteil-Noble, Thomas Rimmelé, Olivier Thaunat, Gilles Blancho, Agnès Chapelet, Clément Deltombe, Lucile Figueres, Raphael Gaisne, Claire Garandeau, Caroline Gourraud-Vercel, Maryvonne Hourmant, Clarisse Kerleau, Delphine Kervella, Aurélie Meurette, Simon Ville, Christine Kandell, Anne Moreau, Florent Delbos, Alexandre Walencik, Anne Devis, Lucile Amrouche, Dany Anglicheau, Olivier Aubert, Lynda Bererhi, Alexandre Loupy, Frank Martinez, Arnaud Méjean, Rébecca Sberro-Soussan, Anne Scemla, Marc-Olivier Timsit, Julien Zuber, Gillian Divard, and Carmen Lefaucheur
- Subjects
body mass index (BMI) ,pre-procurement pancreas suitability score ,pancreas transplantation ,allograft thrombosis ,high blood pressure ,immunothrombosis ,Immunologic diseases. Allergy ,RC581-607 - Abstract
BackgroundAbout 10–20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis.MethodsWe conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers.ResultsPancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers.ConclusionDonor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.
- Published
- 2024
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