The role of early baseline computed tomography in the interpretation of morphological changes after kidney-pancreas transplantation

Abstract

In a prospective study, 17 early baseline computed tomography (CT) scans were obtained 2 or 3 days after simultaneous kidney-pancreas transplantation. Morphological changes and their relevance to the early detection of graft rejection and complications were evaluated. The pancreatic grafts were enlarged and showed signs of mild pancreatitis. Serial scans obtained during the first renal graft rejection episode were compared with the baseline CT scans (n = 7). They showed a significant increase in pancreatic graft size in the case of biopsy-proven severe renal graft rejection (P = 0.008). Normally functioning pancreatic allografts showed a 15%-40% decrease in size 1-6 months after transplantation. We conclude that the morphological changes observed early after transplantation are compatible with mild pancreatitis, which may contribute to the development of pancreatic graft thrombosis. There is an increase in the number of morphological changes during severe rejection, yet enlarged pancreatic grafts appear to recover from transplantation-related damage and regain their normal size without signs of atrophy.

Early protocol computer tomography and endovascular interventions in pancreas transplantation

“…Three grafts failed due to thrombosis, and the authors suggested that early CT can detect morphological changes that may contribute to thrombosis. 33 Kim et al explored the role of day two protocol CTA scans further, in a study like ours. A change in protocol from day two US scans to day two CTA scans was implemented in 119 pancreas transplant patients.…”

Retrospective study on detection, treatment, and clinical outcome of graft thrombosis following pancreas transplantation

“…Whether these patients require anticoagulation, possibly associated with higher bleeding risk, would optimally be investigated in a randomized trial, where patients with grade 2 would be randomized to receive a particular dose of anticoagulation, or even none. The incorporation of CT imaging into clinical practice can't be supported by data from this study, but its usefulness has been studied and published in this journal 25 years ago, and has been part of our clinical protocol since then .…”