Pancreas transplant imaging: an overview.

Low, R. A. L.; Kuni, C C; Letourneau, J G

doi:10.2214/ajr.155.1.2112834

Cited by 33 publications

(12 citation statements)

References 22 publications

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“…CT and angiography may also have a role in detecting complications after resection of the transplant.After operativeremoval of the pan creatic allograft in two cases,the stump of the donor iliac artery conduit at the right common iliac anastomosiswas well seenon CT scans, and bleeding was detectedin one patient. The role of MR imaging is controversial; although MR imaging has shown changes associated with rejection, all patients show abnormalities in the early postoperativeperiod [13,15]. Se rial studieswith correlation to serum amylase levels, serum creatinine levels, and biopsy would help clarify the role of MR imaging in the diagnosisof rejection and pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Imaging of pancreatic transplantation using portal venous and enteric exocrine drainage.

Dachman¹,

Newmark²,

Thistlethwaite³

et al. 1998

American Journal of Roentgenology

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AbrahamH.DaChman1 GeraldineM. Newmark1 J. RichardThistlethwaite,Jr.2 AytekinOto1'3 DavidS. Bruce2 KennethA. Newell2OBJECTIVE. We describethe normalradiologicappearance of pancreatic allografts transplantedusing portal venousdrainagewith enteric drainageof exocrinesecretions. We also describe the radiologic appearanceof postsurgical complications. MATERIALSAND METHODS. Of 56 patients whoreceived pancreatic transplants usingthe portalâ€"enterictechnique, 24 patients subsequently required radiologic examination for sus pected complications involving the pancreatic allograft. Twenty-three patients underwent CT scanning; a total of 58 CT scans were obtained. Nine abdominal sonograms were obtained in five patients, andonepatientunderwentangiography. The radiologicappearance of eachtransplant andthecomplications wereanalyzedretrospectively andcorrelatedwith theclinicalcourse. RESULTS.The mostcommon indications for CT scanning werefever,elevated levelsofserum amylase, and evaluation or follow-up of fluid collections. CT showed the normal and abnormalanatomyof the allograft.Abnormal findingsseenin the 58 CT scansincludedfat stranding (30 scans),ascites(2 1 scans),peripancreatic fluid or pseudocyst( 13 scans),and het erogeneityofthe allograft(five scans). One patienthadpancreaticinfarctionwith pneumatosis and pneumoperitoneum. The allograft was obscured by bowel gas on three sonograms. Four sonograms showed no abnormalities (one Doppler sonogram showed the arterial supply and venous drainage), and one sonogram showed a pseudocyst. In the one patient who underwent angiography, imaging showed no arterial blood flow to the transplant. CONCLUSION. Pancreatic transplantation with portalvenousdrainageand entericdrainageof exocrinesecretionsand the complicationsof suchtransplantation were revealed with CT, sonography, and angiography. Knowledge of normal anatomic configuration will al low proper interpretation of normal and abnormal findings. M ost whole-organ pancreatic trans plantations continue to use the technique first reported by Cony et al. [1] and Nghiem and Cony [2]. With thistechnique, the veins of the pancreatic allograft drain into the systemiccirculation through the externaliliac vein,andthepancreatic exocrine secretions drain into the recipient bladder througha segmentof donor duodenum.Re ported complications of this techniqueinclude dehydrationand acidosis,recurrenturinary tract infections, reflux graft pancreatitis, and hematuria, with the occasional need for con version to enteric drainage [3]. In addition to thesecomplications, systemicvenousdrainage has been reportedto causehyperinsulinemia and peripheral insulin resistance [4â€"7]. In re sponseto experimental evidence of the detri mentaleffectsattributedto systemicdrainage andin anattemptto avoidthesecomplications, described a technique for pancreatic transplantation with portal venousdrainageand entericdrainageof exo crimesecretions. This new techniquehasbeen reportedto decreasethe incidenceof acidosis and dehydrationand to favorably influence lipid profile...

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Section: Discussionmentioning

confidence: 99%

Imaging of pancreatic transplantation using portal venous and enteric exocrine drainage.

Dachman¹,

Newmark²,

Thistlethwaite³

et al. 1998

American Journal of Roentgenology

View full text Add to dashboard Cite

show abstract

“…2); not infrequently, a pancreas graft is difficult to visualize because of adjacent intestinal loops, even when a bladder drainage procedure has been performed. 1,8,9,11 Enterically drained allografts are more difficult to visualize because distention of the urinary bladder cannot be used to aid in localization, and overlying bowel loops are more apt to obscure the graft. The routine ultrasound scan includes examination of the adjacent pelvis and abdominal peritoneal spaces for evidence of free or loculated fluid.…”

Section: Sonographymentioning

confidence: 99%

“…The clinical setting is often nonspecific, and multiple complications frequently coexist. 1 Acute allograft rejection is the most common cause of graft failure, occurring in 35% of pancreas transplants. Abscess formation occurs in as many as 22% of recipients and graft thrombosis in 13% to 20%; both of these complications usually require graft removal for treatment.…”

Section: Complications Of Pancreas Transplantationmentioning

confidence: 99%

“…In the United States alone, there are more than one million insulin-dependent (Type I) diabetic patients; the morbidity and deaths associated with diabetes mellitus are largely attributable to its progressive secondary complications. 1 Because of systemic and cellular abnormalities that develop with inadequate glucose regulation, 50% of persons with Type I diabetes mellitus develop retinopathy, nephropathy, neuropathy, enteropathy, and arterial disease within 20 years of disease onset. 1,2 The accepted therapy for diabetes mellitus is insulin replacement, combined with laser coagulopathy for retinal disease and renal transplantation for renal insufficiency.…”

mentioning

confidence: 99%

“…1 Because of systemic and cellular abnormalities that develop with inadequate glucose regulation, 50% of persons with Type I diabetes mellitus develop retinopathy, nephropathy, neuropathy, enteropathy, and arterial disease within 20 years of disease onset. 1,2 The accepted therapy for diabetes mellitus is insulin replacement, combined with laser coagulopathy for retinal disease and renal transplantation for renal insufficiency. However, investigation has shown that normalization of glucose levels early in the course of the disease can arrest the secondary complications of diabetes mellitus.…”

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