Pancreatic transplantation: surgical technique, normal radiological appearances and complications

Abstract

Pancreas transplantation is a surgical treatment for diabetes mellitus. More than 23,000 pancreas transplants have now been reported to the International Transplant Registry (IPTR). Early diagnosis and therapy for graft-related complications are essential for graft survival. Radiologists must therefore understand the surgical procedure and the potential complications. During the course of this review, we will illustrate the normal post-operative anatomy and the imaging appearances of common potential complications.

Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

“…11,26 Salvage of a completely thrombosed graft is difficult, and immediate relaparotomy and graft pancreatectomy are usually required to avoid further complications related to pancreatic necrosis or duodenal stump breakdown. 27 Recovery from partial thrombosis is possible in certain cases but requires prompt intervention with surgical thrombectomy (most common), percutaneous thrombectomy/thrombolysis, or systemic anticoagulation. These patients may still ultimately require graft pancreatectomy.…”

“…It most frequently presents as pseudoaneurysm or aortoenteric fistula and less commonly as an arteriovenous or aortourinary fistula. 27,31 While these findings may go unnoticed for extended periods of time, they may ultimately result in life-threatening bleeding complications.…”

“…However, in many cases, conventional or CT angiography is more valuable to show active contrast extravasation or other arterial abnormality. 27 Conservative management with transfusion and observation is the mainstay of therapy in early postoperative hemorrhage; however, hemorrhage continues to be one of the most common reasons for relaparotomy after transplantation. Persistent symptoms may also require investigation with angiography to localize a bleeding source.…”

Imaging in pancreas transplantation complications: Temporal classification

“…4 Although it is a typical immediate complication, it can occur within the first 3 months following transplantation. 4 Although it is a typical immediate complication, it can occur within the first 3 months following transplantation.…”

“…Graft arterial thrombosis is the most severe vascular complication that often results in graft dysfunction and failure. 4 Although it is a typical immediate complication, it can occur within the first 3 months following transplantation. 5 The ultrasound findings are tardus parvus waveforms of the intrapancreatic arteries, absent arterial signal in the Y graft ( Fig.…”