mycophenolic-acid and Venous-Thrombosis

Despite advances in immunosuppression and surgical technique, pancreas transplantation is encumbered with a high rate of complication and graft losses. Particularly, venous graft thrombi occur relatively frequently and are rarely detected before the transplant is irreversibly damaged.. To detect complications early, when the grafts are potentially salvageable, we placed microdialysis catheters anteriorly and posteriorly to the graft in a cohort of 34 consecutive patients. Glucose, lactate, pyruvate, and glycerol were measured at the bedside every 1-2 hours.. Nine patients with graft venous thrombosis had significant lactate and lactate-to-pyruvate-ratio increases without concomitant rise in blood glucose or clinical symptoms. The median lactate in these patients was significantly higher in both catheters compared to non-events (n = 15). Out of the nine thrombi, four grafts underwent successful angiographic extraction, one did not require intervention and four grafts were irreversibly damaged and explanted. Four patients with enteric anastomosis leakages had significantly higher glycerol measurements compared to non-events. As with the venous thrombi, lactate and lactate-to-pyruvate ratio were also increased in six patients with graft surrounding hematomas.. Bedside monitoring with microdialysis catheters is a promising surveillance modality of pancreatic grafts, but differentiating between the various pathologies proves challenging.

Topics: Adult; Antilymphocyte Serum; Catheters, Indwelling; Early Diagnosis; Feasibility Studies; Female; Glucose; Glycerol; Graft Rejection; Hematoma; Humans; Immunosuppressive Agents; Lactic Acid; Male; Microdialysis; Middle Aged; Monitoring, Physiologic; Mycophenolic Acid; Pancreas Transplantation; Pyruvic Acid; Tacrolimus; Venous Thrombosis

Topics: Adult; Female; Fever; Humans; Immunocompromised Host; Lupus Erythematosus, Systemic; Lupus Nephritis; Muscle, Skeletal; Mycophenolic Acid; Prednisone; Prognosis; Pyomyositis; Tuberculosis; Venous Thrombosis

A patient presented with erysipelas and developed deep venous thrombosis (DVT) and later idiopatic thrombocytopenic purpura (ITP). In the literature we find no reports of ITP following DVT. It is well known that patients can develop HIT after DVT or DVT after ITP, both caused by the medicine used for treatment. Patients have developed ITP after heparin-induced thrombocytopenia (HIT). Cases are also described in which heparin antibodies are found, but in which the final diagnosis was ITP. The diagnosis of the patient in our case story could be ITP based on DVT, but with no history of HIT. Alternatively, he could have developed two complications to an infection.

Topics: Aged; Anti-Bacterial Agents; Anticoagulants; Dexamethasone; Erysipelas; Heparin; Humans; Male; Mycophenolic Acid; Purpura, Thrombocytopenic, Idiopathic; Thrombocytopenia; Treatment Outcome; Venous Thrombosis

Topics: Azathioprine; Calcineurin Inhibitors; Child; Continuity of Patient Care; Glucocorticoids; Graft Rejection; Hepatic Artery; Humans; Immunosuppressive Agents; Liver Transplantation; Long-Term Care; Monitoring, Physiologic; Mycophenolic Acid; Portal Vein; Postoperative Complications; Primary Graft Dysfunction; Recurrence; Survivors; Venous Thrombosis; Virus Diseases

Topics: Adult; Calcineurin Inhibitors; Case-Control Studies; Female; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Prednisone; Risk; Sarcoma, Kaposi; TOR Serine-Threonine Kinases; Treatment Outcome; Venous Thrombosis

Heparin is commonly used as an anticoagulant but its many other pharmacologic properties are less well known. It has an important effect on complement regulation and has been shown in vitro to inhibit complement-mediated lysis of red cells. Although the beneficial effects of heparin for treatment of haemolytic anaemia were described many decades ago, its use in this scenario is not standard practice. Here we report a case where the use of heparin had a beneficial effect on a life-threatening episode of intravascular haemolysis. We also show unfractionated heparin to be more beneficial than low molecular weight heparin. We suggest that heparin has an important role to play in the management of complement-mediated haemolytic episodes.

Topics: 3' Untranslated Regions; Acute Disease; Adult; Anemia, Hemolytic, Autoimmune; Azathioprine; Combined Modality Therapy; Complement Activation; Enoxaparin; Female; Hemolysis; Heparin; Humans; Immunosuppressive Agents; Mycophenolic Acid; Plasma Exchange; Prednisolone; Prothrombin; Splenectomy; Thrombophilia; Venous Thrombosis

Topics: Factor V; Female; Heterozygote; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Venous Thrombosis