Introduction: Transplant thrombosis is the main cause of early pancreas failure. Factors related to the donor, to the recipient (rheological disorders, overweight) and a prolonged cold ischemia time are associated thrombosis which seems to be linked to transplant pancreatitis. Tumor necrosis factor alpha inhibitor (TNFi), has anti-inflammatory properties which could reduce transplant pancreatitis and consequently the rate of venous thrombosis. We prospectively evaluated the safety and efficiency of TNFI induction therapy on the rate of venous thrombosis.

Methods: TNFi was introduced into clinical practice in our center in April 2017. Etanercept was administred at day 0 (50 mg), day 3, 7 and 10 (25 mg) in combination to anti-thymocyte globulin, 5-day steroids, tacrolimus and mycophenolic acid. Patients with a minimum one-year follow-up were compared to patients transplanted before April 2017.

Results: Between April 2017 and December 2020, 60 pancreas transplant recipients received TNFi and were compared to the last 60 recipients transplanted before April 2017. Sociodemographic characteristics of recipients and donors were similar. Most transplantations were SPK  (79%). Tolerance of Etanercept was excellent (no case of discontinuation). The rate of thrombosis in the TNFi group was 13.6% versus 25% in the control group at 1 month (p=0.11). No thrombosis occured after 1 month. One month and 1-year transplant survival rates were respectively 96.6% and 93.2% in the TNFi group and 93.3% and 88.3% in the control group (p=0.23). One month and 1-year patient survival rates were 100% in the TNFi group and 96.7% in the control group (p=0.27). The rates of CMV  infections were similar in the 2 groups. No case of tuberculosis was observed.

Conclusion: The perioperative administration of TNFi in pancreatic transplantation appears to be safe and may decrease the rate of transplant venous thrombosis.