Pancreas graft thrombosis: Prompt diagnosis and immediate thrombectomy or retransplantation

The cause of venous thrombosis in pancreas transplantation is generally not known and usually requires urgent pancreatectomy. In this report we describe 2 patients with pancreas graft thrombosis that occurred 2 and 6 days posttransplant in which surgical treatment was successful with immediate retransplantation in 1 case and portal venous thrombectomy in the other. When venous thrombosis is suspected, duplex-Doppler ultrasonography should be performed and, with findings of well-localized thrombi with absent venous flow in the presence of well-preserved arterial supply, a thrombectomy should be attempted as the first choice; this operation should be performed in the presence of a suitable donor to offer retransplantation. Complication in the patient with pancreas retransplantation was one episode of kidney rejection; a urinary fistula arose in the patient in whom venous thrombectomy was performed. Both patients have kidney and pancreas grafts functioning after more than 1 and 2 years.