The efficacy of therapeutic anticoagulation in pancreas allograft thrombosis according the CPAT grading system

S.A. Simonis, B.M. de Kok, J.C. Korving, W.H. Kopp, A.G. Baranski, V.A.L. Huurman, P.J.M. van der Boog, M.N.J.M. Wasser, A.E. Braat

Wednesday 4 march 2020

14:00 - 14:10h at Theaterzaal

Parallel session: Parallel sessie III – Klinische abstracts

Efficacy of anticoagulative treatment in pancreas allograft thrombosis has been extensively studied. However, conflicting outcomes of these studies, specifically for partial thrombosis, have not resulted in a universally applied anticoagulation protocol. This study was designed to separately evaluate the efficacy of anticoagulative treatment in the different grades of pancreas allograft thrombosis according the Cambridge Pancreas Allograft Thrombosis (CPAT) grading system. The CPAT grading system distinguishes four grades of thrombosis: no thrombosis (CPAT-0), peripheral thrombosis (CPAT-1), intermediate non-occlusive thrombosis (CPAT-2) and central occlusive thrombosis (CPAT-3). All 177 pancreas transplantations performed at our center between January 1st, 2008 and September 1st, 2018 were included. Overall 5-year patient survival in this cohort was 88.6%. Patient survival was not affected by administration of anticoagulation in any grade of thrombosis. The overall 5-year graft survival in this cohort was 86.3%. In patients with CPAT-0 (p=0.715) and CPAT-1 (p=0.267), administration of anticoagulative treatment did not contribute to significantly better graft survival. In contrast, in patients with CPAT-2, administration of anticoagulative treatment showed a significantly better graft survival as compared to patients that did not receive anticoagulative treatment. (p=0.015). Due to the small number of patients with CPAT-3, analysis of the effect of anticoagulation was not performed in this category.

Conclusion: Based on our results, implementation of the CPAT grading system into our clinical practice would be desirable. Followed by adjustment of the current anticoagulation protocol to administration of anticoagulation solely in patients with CPAT-2.