Imaging in pancreatic transplants

Heller, Matthew T.; Bhargava, Puneet

doi:10.4103/0971-3026.143896

Cited by 9 publications

(4 citation statements)

References 48 publications

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“…Absent or reversed arterial diastolic flow was present in 45.0% (nine of 20) of failed transplants and had the highest specificity of the three US findings (92.7% [193 of 208]) when considered individually. Splenic vein thrombus, an observation that is widely used to guide management (11)(12)(13)(14)(15)(16)(17), was present in 10 transplants that failed; however, it was also present in a higher number of transplants that survived (10.9% [25 of 228]). It is important to note that nine of the 10 failed transplants with grade 2 splenic vein thrombus also had absent or reversed arterial diastolic flow.…”

Section: Discussionmentioning

confidence: 99%

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US Findings in Patients at Risk for Pancreas Transplant Failure

Morgan¹,

Smith‐Bindman²,

Harbell³

et al. 2016

Radiology

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Purpose To determine if ultrasonographic (US) findings, including Doppler US findings, are associated with subsequent pancreas transplant failure. Materials and Methods A cohort of adult patients who underwent pancreas transplantation at a tertiary institution over the course of 10 years (from 2003 to 2012) was retrospectively evaluated for failure, which was defined as return to insulin therapy or surgical graft removal. The institutional review board provided a waiver of informed consent. All US images obtained within the 1st postoperative year were reviewed for three findings: arterial flow (presence or absence of intraparenchymal forward diastole flow), splenic vein thrombus, and edema. These findings were correlated with pancreas graft failure within 1-year after surgery by using Cox proportional hazards models and hazard ratios. Results A total of 228 transplants were included (mean patient age, 41.6 years; range, 19-57 years; 122 men, 106 women). Absent or reversed arterial diastolic flow was identified in nine of 20 failed transplants (sensitivity, 45%; 95% confidence interval [CI]: 23, 68) and in 15 of 208 transplants that survived (specificity, 93% [193 of 208]; 95% CI: 89, 96). The Cox proportional hazard ratio was 6.2 (95% CI: 3.1, 12.4). Splenic vein thrombus was identified in 10 of 20 failed transplants (sensitivity, 50%; 95% CI: 27, 73) and in 25 of 208 transplants that survived (specificity, 88% [183 of 208]; 95% CI: 83, 92). The Cox proportional hazard ratio was 4.2 (95% CI: 2.4, 7.4). Edema had the lowest specificity (Cox proportional hazard ratio, 2.0; 95% CI: 1.3, 2.9). In the multivariate analysis, only absent or reversed arterial diastolic flow remained significantly associated with transplant failure (adjusted hazard ratio, 3.6; 95% CI: 1.0, 12.8; P = .045). Conclusion Absent or reversed diastolic arterial Doppler flow has a stronger association with transplant failure than does splenic vein thrombus or edema. (©) RSNA, 2016.

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Section: Discussionmentioning

confidence: 99%

“…This finding can be subjective and difficult to quantify. It has been described as a decrease in echogenicity of the graft, an increase in graft size, and a globular graft appearance; however, no quantitative measurements have been described (14). Edema was deemed present if any of these subjective parameters were observed (Figs 2, 3).…”

Section: Us Image Reviewmentioning

confidence: 99%

US Findings in Patients at Risk for Pancreas Transplant Failure

Morgan¹,

Smith‐Bindman²,

Harbell³

et al. 2016

Radiology

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“…Achieving normoglycemia in insulin-dependent diabetic patients is the primary indication for pancreas transplant (PT), first performed in 1966, with the secondary benefit of limiting the sequelae of uncontrolled diabetes, such as diabetic nephropathy and retinopathy (110)(111)(112). While not performed as frequently as LTs, PTs are increasingly performed with 213 performed in the United States in 2017 compared to 78 in 1988, all of which were from deceased donors (7).…”

Section: Pancreatic Transplantationmentioning

confidence: 99%

Pre-hepatic and pre-pancreatic transplant donor evaluation

Cahalane¹,

Mojtahed²,

Sahani³

et al. 2019

Cardiovasc. Diagn. Ther.

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Innovations in surgical techniques coupled with advances in medical and pharmacological management in the past few decades have enabled organ transplantation to become integral to the management of end stage organ failure. In this review article, we will review the role of the radiologist in the work up of liver and pancreas donors during evaluation of their donor candidacy. The critical role of imaging in assessing the parenchymal, biliary and vascular anatomy in liver donor candidates will be reviewed, as well as highlighting the anatomical findings that may pose a contraindication to transplantation. The limited role of imaging in pancreas donor evaluation is also covered, as well as a brief overview of the surgical techniques available and how the radiologist's findings influence operative technique selection.

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“…Ultrasound is considered a safe, non-invasive, nonradiative, simple, quick, repeatable, and removable approach. It is also the preferred initial imaging modality for evaluating the transplanted pancreas, whereby grayscale assesses the parenchyma and fluid collections, and color Doppler ultrasonography delineates the vascular anatomy and patency and assesses graft perfusion and viability (4,5). However, ultrasound is often affected by factors such as intestinal gas interference and operator proficiency, partial thromboses may be easily missed (4).…”

Section: Introductionmentioning

confidence: 99%

Comparison of color Doppler ultrasonography and computed tomography angiography (CTA) and computed tomography venography (CTV) in the diagnosis of arteriovenous thrombosis after simultaneous pancreas-kidney transplantation: a retrospective diagnostic accuracy study

Liu¹,

Chen²,

Liu³

et al. 2022

Ann Transl Med

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Background: Simultaneous pancreas-kidney transplantation is an important treatment approach for diabetic renal insufficiency, but pancreatic arteriovenous thrombosis is among the early serious surgical complications that can lead to graft loss and even be fatal. Ultrasound is considered to be a safe and noninvasive approach, but it is often affected by intestinal gas interference and operator proficiency, partial thromboses may be easily missed. Computed tomography angiography (CTA) and computed tomography venography (CTV) are highly accurate but radiative, requiring the use of contrast agents. Methods: A total of 194 patients with end-stage diabetic nephropathy who underwent simultaneous pancreas-kidney transplantation from September 2016 to May 2021 were selected, among which 32 patients with highly suspected arteriovenous thrombosis were enrolled as the research subjects. All patients were examined by color Doppler ultrasonography, CTA and CTV. CTA and CTV are the gold standard for diagnostic imaging. The diagnostic value of color Doppler ultrasound, CTA and CTV in the diagnosis of pancreatic arteriovenous thrombosis was compared. and Kappa coefficient was used for consistency test.Results: Among the 32 patients with high clinical suspicion of transplanted pancreatic arteriovenous thrombosis after simultaneous pancreas-kidney transplantation, 9 patients were diagnosed by CTA/CTV and 10 patients were diagnosed by color Doppler ultrasonography, of which 2 cases were false positive and 1 case false negative. After transplantation, the normal diameter of the donor splenic vein was 3.96±0.16 mm.The difference in the diameter of the donor splenic vein between those with and without donor splenic vein thrombosis was statistically significant (P<0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of color Doppler ultrasound in the diagnosis of arteriovenous thrombosis were 88.9%, 91.3%, 90.6%, 80%, and 95.5%, respectively. There was no significant difference between color Doppler ultrasound diagnosis of arteriovenous thrombosis and CTA and CTV results (McNemar test P=1). The diagnosis of arteriovenous thrombosis by color Doppler ultrasonography was consistent with that of CTA and CTV (Kappa coefficient =0.776). Conclusions: Color Doppler ultrasonography has the advantages of safety and radiation-free, and can be used as the first choice for diagnosis of pancreatic arteriovenous thrombosis after simultaneous pancreaskidney transplantation.

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Imaging in pancreatic transplants

Cited by 9 publications

References 48 publications

US Findings in Patients at Risk for Pancreas Transplant Failure

US Findings in Patients at Risk for Pancreas Transplant Failure

Pre-hepatic and pre-pancreatic transplant donor evaluation

Comparison of color Doppler ultrasonography and computed tomography angiography (CTA) and computed tomography venography (CTV) in the diagnosis of arteriovenous thrombosis after simultaneous pancreas-kidney transplantation: a retrospective diagnostic accuracy study

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