Frontiers in Immunology (May 2024)

The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis

  • Christophe Masset,
  • Christophe Masset,
  • Julien Branchereau,
  • Julien Branchereau,
  • Fanny Buron,
  • Georges Karam,
  • Georges Karam,
  • Maud Rabeyrin,
  • Karine Renaudin,
  • Karine Renaudin,
  • Florent Le Borgne,
  • Lionel Badet,
  • Xavier Matillon,
  • Christophe Legendre,
  • Denis Glotz,
  • Corinne Antoine,
  • Magali Giral,
  • Magali Giral,
  • Jacques Dantal,
  • Jacques Dantal,
  • Diego Cantarovich,
  • Diego Cantarovich,
  • DIVAT Consortium,
  • Lionel Badet,
  • Maria Brunet,
  • Fanny Buron,
  • Rémi Cahen,
  • Ricardo Codas,
  • Sameh Daoud,
  • Valérie Dubois,
  • Coralie Fournie,
  • Arnaud Grégoire,
  • Alice Koenig,
  • Charlène Lévi,
  • Emmanuel Morelon,
  • Claire Pouteil-Noble,
  • Maud Rabeyrin,
  • Thomas Rimmelé,
  • Olivier Thaunat,
  • Gilles Blancho,
  • Julien Branchereau,
  • Diego Cantarovich,
  • Agnès Chapelet,
  • Jacques Dantal,
  • Clément Deltombe,
  • Lucile Figueres,
  • Raphael Gaisne,
  • Claire Garandeau,
  • Magali Giral,
  • Caroline Gourraud-Vercel,
  • Maryvonne Hourmant,
  • Georges Karam,
  • Clarisse Kerleau,
  • Delphine Kervella,
  • Christophe Masset,
  • Aurélie Meurette,
  • Simon Ville,
  • Christine Kandell,
  • Anne Moreau,
  • Karine Renaudin,
  • Florent Delbos,
  • Alexandre Walencik,
  • Anne Devis,
  • Lucile Amrouche,
  • Dany Anglicheau,
  • Olivier Aubert,
  • Lynda Bererhi,
  • Christophe Legendre,
  • Alexandre Loupy,
  • Frank Martinez,
  • Arnaud Méjean,
  • Rébecca Sberro-Soussan,
  • Anne Scemla,
  • Marc-Olivier Timsit,
  • Julien Zuber,
  • Gillian Divard,
  • Carmen Lefaucheur,
  • Denis Glotz

DOI
https://doi.org/10.3389/fimmu.2024.1359381
Journal volume & issue
Vol. 15

Abstract

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BackgroundAbout 10–20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis.MethodsWe conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers.ResultsPancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers.ConclusionDonor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.

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