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| 1 | Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?显示文摘BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to occur.Conventional coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated.Thromboelastogram(TEG)is an in-vitro diagnostic test which is used in liver transplantation,and in various intensive care settings to guide anticoagulation.TEG is better than CCT because it is dynamic and provides a global hemostatic profile including fibrinolysis.AIM To compare the outcomes between TEG and CCT(prothrombin time,activated partial thromboplastin time and international normalized ratio)directed anticoagulation in simultaneous pancreas and kidney(SPK)transplant recipients.METHODS A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients,who were matched for donor age and graft type(donors after brainstem death and donors after circulatory death).Anticoagulation consisted of intravenous(IV)heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG results.Graft loss due to thrombosis,anticoagulation related bleeding,radiological incidence of partial thrombi in the pancreas graft,thrombus resolution rate after anticoagulation dose escalation,length of the hospital stays and,1-year pancreas and kidney graft survival between the two groups were compared.RESULTS Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients(ratio of 1:3)who were anticoagulated based on CCT.No graft losses occurred in the TEG group,whereas 11 grafts(7 pancreases and 4 kidneys)were lost due to thrombosis in the CCT group(P=0.06,Fisher’s exact test).The overall incidence of anticoagulation related bleeding(hematoma/gastrointestinal bleeding/hematuria/nose bleeding/re-exploration for bleeding/post-operative blood transfusion)was 17.65%in the TEG group and 45.10%in the CCT group(P=0.05,Fisher’s exact test).The incidence of radiologically confirmed partial thrombus in pancreas allograft was 41.18%in the TEG and 25.50%in the CCT group(P=0.23,Fisher’s exact test).All recipients with partial thrombi detected in computed tomography(CT)scan had an anticoagulation dose escalation.The thrombus resolution rates in subsequent scan were 85.71%and 63.64%in the TEG group vs the CCT group(P=0.59,Fisher’s exact test).The TEG group had reduced blood product usage{10 packed red blood cell(PRBC)and 2 fresh frozen plasma(FFP)}compared to the CCT group(71 PRBC/10 FFP/2 cryoprecipitate and 2 platelets).The proportion of patients requiring transfusion in the TEG group was 17.65%vs 39.25%in the CCT group(P=0.14,Fisher’s exact test).The median length of hospital stay was 18 days in the TEG group vs 31 days in the CCT group(P=0.03,Mann Whitney test).The 1-year pancreas graft survival was 100%in the TEG group vs 82.35%in the CCT group(P=0.07,log rank test)and,the 1-year kidney graft survival was 100%in the TEG group vs 92.15%in the CCT group(P=0.23,log tank test).CONCLUSION TEG is a promising tool in guiding judicious use of anticoagulation with concomitant prevention of graft loss due to thrombosis,and reduces the length of hospital stay. | Jeevan Prakash Gopal Frank JMF Dor Jeremy S Crane Paul E Herbert Vassilios E Papalois Anand SR Muthusamy | 2020 | World Journal of Transplantation2020，10，7： | 2 |
| 2 | Gaussian Mixture Discriminant Analysis and Sub-pixel Land Cover Characterization in Remote Sensing 显示文摘 | JU J C KOLACZYK E D GOPAL S | 2003 | Remote Sensing Environment2003，84，： | 1 |
| 3 | Increased cell density decreases eysteine proteinase inhibitor activity and increases invasive ability of two prostate tumor cell lines显示文摘 | COLELLA R GOODWYN E GOPAL P | 2002 | Cancer Letters2002，185，2： | 1 |
| 4 | Fuzzy set theory and thematic maps: accuracy assessment and area estimation显示文摘 | Woodcock C E Gopal S | 2000 | International Journal of Geographical Information Science2000，14，2： | 1 |
| 5 | Highly-ordered TiO2 Nanotube Arrays up to 220 txm in Length:Use in Water Photoelectrolysis and Dye-sensitized Solar Cells 显示文摘 | SHANKAR Karthik MOR Gopal K PRAKASAM1 Haripriya E | 2007 | Nanotechnology2007，18，06： | 1 |
| 6 | Expression of slc5a8 in kidney and its role in Naq--coupled transport of lactate显示文摘 | Gopal E Fei Y Sugawara M | 2004 | The Journal of Biological Chemistry2004，279，44： | 1 |
| 7 | Hsp90 as a gatekeeper of tumor angiogenesis:clinical promise and potential pitfalls显示文摘 | Bohonowych J E Gopal U Isaacs J S | | 0，，： | 1 |
| 8 | Parthenolide promotes the ubiquitination of MDM2 and activates p53 cellular functions 显示文摘 | Gopal YN Chanchorn E Van Dyke MW | 2009 | Mol Cancer Ther2009，8，5： | 1 |
| 9 | Formation of metastable pi-phase in mechanically alloyed tellurium-rich Ag-Te alloys显示文摘 | Raviprasad K Gopal E S R Chattopadhydy K | 1995 | J Mater Resea1995，10，8： | 1 |
| 10 | Functional identification of SLC5A8,a tumor suppressor down-regulated in colon cancer,as a Na(+)-coupled transporter for short-chain fatty acids显示文摘 | Miyauchi S Gopal E Fei YJ | 2004 | J Biol Chem2004，279，13： | 1 |
| 11 | Cloning and functional characterization of human SMCT2 (SLC5A12) and expression pattern of the transporter in kidney 显示文摘 | Gopal E Umapahy NS Martin PM | 2007 | Biochim Biophysica Acta2007，1768，11： | 1 |
| 12 | Expression of slc5a8 in kidney and its role in Na(+)-coupled transport of lactate显示文摘 | Gopal E Fei YJ Sugawara M | 2004 | J Biol Chem2004，279，44： | 1 |
| 13 | A dynamic liquid support system for continuous electrospun yarn fabrication 显示文摘 | Teo W E Gopal R Ramaseshan R | 2007 | Polymer2007，48，： | 1 |
| 14 | Expression of sle5a8 in kidney and its role in Na^+ -coupled transporter of lactate显示文摘 | Gopal E Fei Y J Sugawara M | 2004 | J Biol Chem2004，279，44： | 1 |
| 15 | Gaussian Mixture Discriminant Analysis and Sub-pixel Land Cover Characterization in Remote Sensing显示文摘 | Ju Junchang Kolaczyk E D Gopal S | 2003 | Remote Sensing of Environment2003，84，： | 1 |
| 16 | Sodium-coupled and electrogenic transport of B-complex vitamin nicotinic acid by slc5a8,a member of the Na/glucose co-transporter gene family显示文摘 | Gopal E Fei YJ Miyanchi S | 2005 | Biochem J2005，388，1： | 1 |
| 17 | Sodiumcoupled monocarboxylate transporters in normal tissues and in cancer显示文摘 | Ganapatby V Thangaraju M Gopal E | 2008 | AAPS2008，10，1： | 1 |
| 18 | Results of a pivotal phase Ⅱ study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma显示文摘 | Younes A Gopal A K Smith S E | 2012 | J Clin Oncol2012，30，18： | 1 |
| 19 | Resuhs of a pivotal phase 11 study of brentuximab vedotin for patients with relapsed or refractory Hodgkin' s lymphoma 显示文摘 | YOUNES A GOPAL A K SMITH S E | 2012 | J Clin Oneol2012，30，18： | 1 |
| 20 | Expression of slc5a8 in kidney andits role in Na(+) -coupled transport of lactate显示文摘 | Gopal E Fei YJ Sugawara M | 2004 | J Biol Chem2004，279，44： | 1 |
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