AUTHOR=Masset Christophe , Branchereau Julien , Buron Fanny , Karam Georges , Rabeyrin Maud , Renaudin Karine , Le Borgne Florent , Badet Lionel , Matillon Xavier , Legendre Christophe , Glotz Denis , Antoine Corinne , Giral Magali , Dantal Jacques , Cantarovich Diego , DIVAT Consortium , Badet Lionel , Brunet Maria , Buron Fanny , Cahen Rémi , Codas Ricardo , Daoud Sameh , Dubois Valérie , Fournie Coralie , Grégoire Arnaud , Koenig Alice , Lévi Charlène , Morelon Emmanuel , Pouteil-Noble Claire , Rabeyrin Maud , Rimmelé Thomas , Thaunat Olivier , Blancho Gilles , Branchereau Julien , Cantarovich Diego , Chapelet Agnès , Dantal Jacques , Deltombe Clément , Figueres Lucile , Gaisne Raphael , Garandeau Claire , Giral Magali , Gourraud-Vercel Caroline , Hourmant Maryvonne , Karam Georges , Kerleau Clarisse , Kervella Delphine , Masset Christophe , Meurette Aurélie , Ville Simon , Kandell Christine , Moreau Anne , Renaudin Karine , Delbos Florent , Walencik Alexandre , Devis Anne , Amrouche Lucile , Anglicheau Dany , Aubert Olivier , Bererhi Lynda , Legendre Christophe , Loupy Alexandre , Martinez Frank , Méjean Arnaud , Sberro-Soussan Rébecca , Scemla Anne , Timsit Marc-Olivier , Zuber Julien , Divard Gillian , Lefaucheur Carmen , Glotz Denis TITLE=The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis JOURNAL=Frontiers in Immunology VOLUME=15 YEAR=2024 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1359381 DOI=10.3389/fimmu.2024.1359381 ISSN=1664-3224 ABSTRACT=Background

About 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.

Methods

We 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.

Results

Pancreas 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.

Conclusion

Donor 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.