Portal Vein Thrombosis after Total Pancreatectomy and Islet Autotransplant: Prophylaxis and Graft Impact

Alexandria J. Robbins; Mariya E. Skube; Melena D. Bellin; Ty B. Dunn; Scott A. Chapman; K. Louise Berry; Elizabeth Lusczek; Gregory J. Beilman

doi:10.1097/MPA.0000000000001421

Portal Vein Thrombosis after Total Pancreatectomy and Islet Autotransplant: Prophylaxis and Graft Impact

Alexandria J. Robbins, Mariya E. Skube, Melena D. Bellin, Ty B. Dunn, Scott A. Chapman, K. Louise Berry, Elizabeth Lusczek, Gregory J. Beilman

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Objectives To determine the rate of portal vein thrombosis (PVT) based on pharmacologic prophylaxis protocol and the impact of PVT on islet graft function after total pancreatectomy with islet autotransplantation (TPIAT). Methods We compared the incidence of PVT, postsurgical bleeding, and thrombotic complications in patients undergoing TPIAT between 2001 and 2018 at the University of Minnesota who received either unfractionated heparin (UFH) or enoxaparin for postoperative PVT prophylaxis. Six-month and 1-year graft function was compared between patients who developed PVT and those who did not. Results Twelve patients (6.6%) developed a PVT, which resolved by 6 months after TPIAT in 10 patients. There was no statistically significant difference in PVT rate between patients who received UFH or enoxaparin for prophylaxis (P = 0.54). Patients who received enoxaparin developed other thrombotic complications more often (6% vs 0%, P = 0.02). Islet graft function did not differ in patients who developed PVT versus those who did not. Conclusions There was no difference between enoxaparin or UFH prophylaxis in preventing PVT, but there may be a higher incidence of other thrombotic complications with enoxaparin. In the setting of routine screening and anticoagulation therapy, PVT is a self-limited process.

Original language	English (US)
Pages (from-to)	1329-1333
Number of pages	5
Journal	Pancreas
Volume	48
Issue number	10
DOIs	https://doi.org/10.1097/MPA.0000000000001421
State	Published - Nov 1 2019

Bibliographical note

Funding Information:
From the Departments of *Surgery, †Medicine, and ‡Pediatrics, University of Minnesota Medical School, Minneapolis, MN; §Department of Surgery, University of Pennsylvania, Philadelphia, PA; and ||Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN. Received for publication May 21, 2019; accepted September 13, 2019. Address correspondence to: Gregory J. Beilman, MD, Division of Critical Care and Acute Care Surgery, Department of Surgery, University of Minnesota, MMC 195, 420 Delaware St SE, Minneapolis, MN 55455 (e‐mail: [email protected]). Research by G.J.B. and M.E.S. is funded by the National Institutes of Health (T32DK108733). Research by G.J.B. and A.J.R. are funded by DOD (W81XWH18106872). The authors declare no conflict of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001421

Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

TPIAT
anticoagulation
islet graft function
portal vein thrombosis

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10.1097/MPA.0000000000001421

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@article{afeec057016549ba993eb32c321ac376,

title = "Portal Vein Thrombosis after Total Pancreatectomy and Islet Autotransplant: Prophylaxis and Graft Impact",

abstract = "Objectives To determine the rate of portal vein thrombosis (PVT) based on pharmacologic prophylaxis protocol and the impact of PVT on islet graft function after total pancreatectomy with islet autotransplantation (TPIAT). Methods We compared the incidence of PVT, postsurgical bleeding, and thrombotic complications in patients undergoing TPIAT between 2001 and 2018 at the University of Minnesota who received either unfractionated heparin (UFH) or enoxaparin for postoperative PVT prophylaxis. Six-month and 1-year graft function was compared between patients who developed PVT and those who did not. Results Twelve patients (6.6%) developed a PVT, which resolved by 6 months after TPIAT in 10 patients. There was no statistically significant difference in PVT rate between patients who received UFH or enoxaparin for prophylaxis (P = 0.54). Patients who received enoxaparin developed other thrombotic complications more often (6% vs 0%, P = 0.02). Islet graft function did not differ in patients who developed PVT versus those who did not. Conclusions There was no difference between enoxaparin or UFH prophylaxis in preventing PVT, but there may be a higher incidence of other thrombotic complications with enoxaparin. In the setting of routine screening and anticoagulation therapy, PVT is a self-limited process.",

keywords = "TPIAT, anticoagulation, islet graft function, portal vein thrombosis",

author = "Robbins, {Alexandria J.} and Skube, {Mariya E.} and Bellin, {Melena D.} and Dunn, {Ty B.} and Chapman, {Scott A.} and Berry, {K. Louise} and Elizabeth Lusczek and Beilman, {Gregory J.}",

note = "Funding Information: From the Departments of *Surgery, †Medicine, and ‡Pediatrics, University of Minnesota Medical School, Minneapolis, MN; §Department of Surgery, University of Pennsylvania, Philadelphia, PA; and ||Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN. Received for publication May 21, 2019; accepted September 13, 2019. Address correspondence to: Gregory J. Beilman, MD, Division of Critical Care and Acute Care Surgery, Department of Surgery, University of Minnesota, MMC 195, 420 Delaware St SE, Minneapolis, MN 55455 (e‐mail: [email protected]). Research by G.J.B. and M.E.S. is funded by the National Institutes of Health (T32DK108733). Research by G.J.B. and A.J.R. are funded by DOD (W81XWH18106872). The authors declare no conflict of interest. Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001421 Publisher Copyright: {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2019",

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language = "English (US)",

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T1 - Portal Vein Thrombosis after Total Pancreatectomy and Islet Autotransplant

T2 - Prophylaxis and Graft Impact

AU - Robbins, Alexandria J.

AU - Skube, Mariya E.

AU - Bellin, Melena D.

AU - Dunn, Ty B.

AU - Chapman, Scott A.

AU - Berry, K. Louise

AU - Lusczek, Elizabeth

AU - Beilman, Gregory J.

N1 - Funding Information: From the Departments of *Surgery, †Medicine, and ‡Pediatrics, University of Minnesota Medical School, Minneapolis, MN; §Department of Surgery, University of Pennsylvania, Philadelphia, PA; and ||Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN. Received for publication May 21, 2019; accepted September 13, 2019. Address correspondence to: Gregory J. Beilman, MD, Division of Critical Care and Acute Care Surgery, Department of Surgery, University of Minnesota, MMC 195, 420 Delaware St SE, Minneapolis, MN 55455 (e‐mail: [email protected]). Research by G.J.B. and M.E.S. is funded by the National Institutes of Health (T32DK108733). Research by G.J.B. and A.J.R. are funded by DOD (W81XWH18106872). The authors declare no conflict of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001421 Publisher Copyright: © 2019 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objectives To determine the rate of portal vein thrombosis (PVT) based on pharmacologic prophylaxis protocol and the impact of PVT on islet graft function after total pancreatectomy with islet autotransplantation (TPIAT). Methods We compared the incidence of PVT, postsurgical bleeding, and thrombotic complications in patients undergoing TPIAT between 2001 and 2018 at the University of Minnesota who received either unfractionated heparin (UFH) or enoxaparin for postoperative PVT prophylaxis. Six-month and 1-year graft function was compared between patients who developed PVT and those who did not. Results Twelve patients (6.6%) developed a PVT, which resolved by 6 months after TPIAT in 10 patients. There was no statistically significant difference in PVT rate between patients who received UFH or enoxaparin for prophylaxis (P = 0.54). Patients who received enoxaparin developed other thrombotic complications more often (6% vs 0%, P = 0.02). Islet graft function did not differ in patients who developed PVT versus those who did not. Conclusions There was no difference between enoxaparin or UFH prophylaxis in preventing PVT, but there may be a higher incidence of other thrombotic complications with enoxaparin. In the setting of routine screening and anticoagulation therapy, PVT is a self-limited process.

AB - Objectives To determine the rate of portal vein thrombosis (PVT) based on pharmacologic prophylaxis protocol and the impact of PVT on islet graft function after total pancreatectomy with islet autotransplantation (TPIAT). Methods We compared the incidence of PVT, postsurgical bleeding, and thrombotic complications in patients undergoing TPIAT between 2001 and 2018 at the University of Minnesota who received either unfractionated heparin (UFH) or enoxaparin for postoperative PVT prophylaxis. Six-month and 1-year graft function was compared between patients who developed PVT and those who did not. Results Twelve patients (6.6%) developed a PVT, which resolved by 6 months after TPIAT in 10 patients. There was no statistically significant difference in PVT rate between patients who received UFH or enoxaparin for prophylaxis (P = 0.54). Patients who received enoxaparin developed other thrombotic complications more often (6% vs 0%, P = 0.02). Islet graft function did not differ in patients who developed PVT versus those who did not. Conclusions There was no difference between enoxaparin or UFH prophylaxis in preventing PVT, but there may be a higher incidence of other thrombotic complications with enoxaparin. In the setting of routine screening and anticoagulation therapy, PVT is a self-limited process.

KW - TPIAT

KW - anticoagulation

KW - islet graft function

KW - portal vein thrombosis

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Portal Vein Thrombosis after Total Pancreatectomy and Islet Autotransplant: Prophylaxis and Graft Impact

Abstract

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