■单独胰腺移植(PTA)受者受胰腺移植物血栓形成的影响更大,与同时接受胰肾(SPK)的患者相比,移植物丢失。病理生理学未知,但已提示PTA接受者的免疫反应增加。在这项观察性研究中,我们比较了PTA(n=32)和SPK(n=35)受者围手术期血栓炎症,在有(n=14)和没有(n=18)早期移植物血栓形成的PTA接受者之间。
■我们测量了C反应蛋白(CRP),活化凝血和补体的血浆标志物,术前和术后第一周每天的细胞因子。
■术前,PTA和SPK受体之间的凝血和补体激活标志物具有可比性,而SPK受体的细胞因子浓度较高(TNF,IL-8,IP-10,MCP-1,MIP-1α;所有p<0.05)。术后第一天,PTA受者有较高的凝血激活,测量为凝血酶-抗凝血酶复合物(TAT),比SPK接收者(p=0.008)。在术后第一周,PTA受体显示较高的相对细胞因子释放(IL-6,IL-8,G-CSF,IP-10,MCP-1和MIP-1α;所有p<0.05),而SPK接受者显示出更高的绝对细胞因子浓度(TNF,IL-1ra,IL-8,MIP-1α,和IL-4;所有p<0.05)。PTA和SPK接受者表现出相似的末端补体复合物(TCC,sC5b-9)激活。术后第一天,TCC(0.1CAU/ml增加,OR1.2[95%CI1.0-1.5],p=0.02)和CRP(对于10mg/L的增加,OR1.2[95%CI1.0-1.3],p=0.04)与早期移植物血栓形成的风险增加有关。TCC对移植物血栓形成具有特异性,而CRP随着几个并发症而升高。与没有移植物血栓形成的患者相比,PTA接受者的TCC术前(p=0.04)和术后(p=0.03)更高。
■PTA受者术后血栓炎症反应的相对增加更为明显。补体激活与移植物血栓形成的风险增加有关。这项研究表明,先天免疫激活而不是水平升高可能会影响术后早期胰腺移植物血栓形成。
■https://clinicaltrials.gov/ct2/show/NCT01957696,标识符NCT01957696。
Pancreas transplant alone (PTA) recipients are more affected by pancreas graft thrombosis, and graft loss compared to simultaneous pancreas-kidney (SPK) recipients. The pathophysiology is unknown, but an increased immune response has been suggested in the PTA recipients. In this observational study, we compared perioperative thromboinflammation between PTA (n=32) and SPK (n=35) recipients, and between PTA recipients with (n=14) versus without (n=18) early graft thrombosis.
We measured C-reactive protein (CRP), plasma markers of activated coagulation and complement, and cytokines preoperatively and daily during the first postoperative week.
Preoperatively, coagulation and complement activation markers were comparable between PTA and SPK recipients, while cytokine concentrations were higher in SPK recipients (TNF, IL-8, IP-10, MCP-1, MIP-1α; all p<0.05). On the first postoperative day, PTA recipients had higher coagulation activation, measured as thrombin-antithrombin complex (TAT), than SPK recipients (p=0.008). In the first postoperative week, PTA recipients showed higher relative cytokine release (IL-6, IL-8, G-CSF, IP-10, MCP-1, and MIP-1α; all p<0.05) while SPK recipients showed higher absolute cytokine concentrations (TNF, IL-1ra, IL-8, MIP-1α, and IL-4; all p<0.05). PTA and SPK recipients showed similar terminal complement complex (TCC, sC5b-9) activation. On the first postoperative day, TCC (OR 1.2 [95% CI 1.0-1.5] for 0.1 CAU/ml increase, p=0.02) and CRP (OR 1.2 [95% CI 1.0-1.3] for 10 mg/L increase, p=0.04) were associated with an increased risk of early graft thrombosis. TCC was specific for graft thrombosis, while CRP increased with several complications. PTA recipients with compared to those without graft thrombosis had higher TCC pre- (p=0.04) and postoperatively (p=0.03).
The relative increase in postoperative thromboinflammatory response was more pronounced in PTA recipients. Complement activation was associated with an increased risk of graft thrombosis. This study indicates that innate immune activation rather than elevated levels may affect early postoperative pancreas graft thrombosis.
https://clinicaltrials.gov/ct2/show/NCT01957696, identifier NCT01957696.