Objectives

Become familiar with the common anatomical appearances of pancreatic grafts and their normal post-operative appearances across a range of imaging modalities.

Recognise the spectrum of early and late post-operative complications related to pancreatic transplant; i)vascular, ii)enteric and iii)parenchymal.

'What the transplant surgeon wants to know'

Background

Whole organ pancreatic transplantation has revolutionised the management of diabetics either alone, after kidney transplant or, most commonly, as part of simultaneous pancreas-kidney transplantation.

Pancreatic grafts have enteric, vascular and parenchymal complications, with a rate of up to 55% being reported. Up to 30% have arterial or venous thrombosis, and re-laparotomy rates may be as high as one third.

The radiologist is pivotal in providing information on graft perfusion and in early diagnosis of complications; understanding the relevant surgical anatomy is paramount.

Imaging findings OR Procedure findings

-Illustrate pancreatic transplant anatomy, including common surgical variations

-Normal graft post-operative appearances across a range of imaging modalities

-Vascular complications i)venous thrombosis, ii)arterial (Y graft stenosis/occlusion), iii)pseudoaneurysm, iv)arteriovenous fistula

-Parenchymal complications i)peripancreatic collections (duct disruption, haematoma, pseudocyst, seroma and abscesses), ii)pancreatitis

-Enteric complications i)enteric leak and bleeding, ii)fistula, iii)bowel obstruction

-'What the transplant surgeon wants to know'

-Top tips for graft ultrasound

Findings are a combination of US (including contrast-enhanced), CT, MRI, and conventional angiography.

Conclusion

For timely management, it is essential that radiologists appreciate transplant arterial, venous and exocrine anatomy.

There are a huge range of potential complications; i)vascular, ii)parenchymal and iii)enteric.

Ultrasound is typically the first line imaging modality. There is an increasing role for radiological intervention to prevent further surgical intervention.