Abstract
Purpose
To retrospectively investigate the value of magnetic resonance imaging (MRI) in detecting complications following pancreas transplant.
Materials and methods
Institutional review board approved this retrospective HIPAA-compliant study and waived informed patient consent. We identified all allograft pancreas transplant patients at our institution from 2001 to January 2014 who had all pertinent post-transplant imaging and clinical data available. Transplant type was documented. Patients were divided into two groups according to post-transplant period (group A; <12 months, group B; ≥12 months). We evaluated the parenchymal enhancement using contrast-enhanced MRI of the allograft and determined the mean percentage of parenchymal enhancement (MPPE) overall and in various abnormalities, the vessel patency, any peripancreatic fluid collection, and the ductal anatomy. We correlated these with clinical results using t test, χ 2, and Fisher’s exact test; p < 0.05 was considered significant.
Results
51 patients (34 male, mean age 43.7 years) were identified, 28 (55%) of whom had abnormal imaging findings; transplant rejection-related necrosis (n = 7), fluid collections (n = 7), vascular stenosis (n = 4), isolated venous thromboses (n = 3), acute pancreatitis (n = 3), pancreatic and peripancreatic abscesses (n = 2), pseudoaneurysm (n = 1), and small-bowel obstruction (n = 1). Pre vs. post-contrast pancreatic MPPE at 1 min was 120% in the normal allografts and 115% in the allografts with pancreatitis and without necrosis (p > 0.05). MPPE at 1 min was only 9% in the allografts rejections with necrosis/infarction. More complications were found in group A than group B (p < 0.05).
Conclusions
Contrast-enhanced MRI is useful for the non-invasive assessment of pancreas transplant complications.
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References
Robertson RP, Sutherland DE, Kendall DM, et al. (1996) Metabolic characterization of long-term successful pancreas transplants in type 1 diabetes. J Invest Med 44:549–555
Troppmann C, Gruessner AC, Dunn DL, et al. (1998) Surgical complications requiring early relaparotomy after pancreas transplantation: a multivariate risk factor and economic impact analysis of the cyclosporine era. Ann Surg 227:255–268
Sansalone CV, Maione G, Aseni P, et al. (2005) Surgical complications are the main cause of pancreatic allograft loss in pancreas-kidney transplant recipients. Transplant Proc 37:2651–2653
Akisik MF, Sandrasegaran K, Aisen AA, et al. (2006) Dynamic secretin-enhanced MR cholangiopancreatography. Radiographics 26:665–677
Gruessner AC (2011) 2011 update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the international pancreas transplant registry (IPTR). Rev Diabet Stud 8:6–16
Gaber AO, Shokouh-Amiri H, Grewal HP, et al. (1993) A technique for portal pancreatic transplantation with enteric drainage. Surg Gynecol Obstet 177:417–419
Fridell JA, Rogers J, Stratta RJ (2010) The pancreas allograft donor: current status, controversies, and challenges for the future. Clin Transplant 24:433–449
Wong JJ, Krebs TL, Klassen DK, et al. (1996) Sonographic evaluation of acute pancreatic transplant rejection: morphology-Doppler analysis versus guided percutaneous biopsy. AJR 166:803–807
Aideyan OA, Schmidt AJ, Trenkner SW, et al. (1996) CT-guided percutaneous biopsy of pancreas transplants. Radiology 201:825–828
Vandermeer FQ, Manning MA, Frazier AA, et al. (2012) Imaging of whole-organ pancreas transplants. Radiographics 32:411–435
Krebs TL, Daly B, Wong-You-Cheong JJ, et al. (1999) Acute pancreatic transplant rejection: evaluation with dynamic contrast-enhanced MR imaging compared with histopathologic analysis. Radiology 210:437–442
Benz S, Bergt S, Obermaier R, et al. (2001) Impairment of microcirculation in the early reperfusion period predicts the degree of graft pancreatitis in clinical pancreas transplantation. Transplantation 71:759–763
Hagspiel KD, Nandalur K, Burkholder B, et al. (2005) Contrast-enhanced MR angiography after pancreas transplantation: normal appearance and vascular complications. AJR 184:465–473
Yuh WT, Hunsicker LG, Nghiem DD, et al. (1989) Pancreatic transplants: evaluation with MR imaging. Radiology 170:171–177
Fernandez MP, Bernadino ME, Neylan JF, et al. (1991) Diagnosis of pancreatic transplant dysfunction: value of gadopentetate dimeglumine-enhanced MR imaging. AJR 156:1171–1176
Kelcz F, Sollinger HW, Pirsh JD (1991) MRI of the pancreas transplant: lack of correlation between imaging and clinical status. Magn Reson Med 21:30–38
Yuh WT, Wiese JA, Abu-Yousef MM, et al. (1988) Pancreatic transplant imaging. Radiology 167:679–683
Vahey TN, Glazer GM, Francis IR, et al. (1988) MR diagnosis of pancreatic transplant rejection. AJR 150:557–560
Nakhleh RE, Sutherland DE (1992) Pancreas rejection. Significance of histopathologic findings with implications for classification of rejection. Am J Surg Pathol 16:1098–1107
Boeve WJ, Kok T, Tegzess AM, et al. (2001) Comparison of contrast enhanced MR-angiography-MRI and digital subtraction angiography in the evaluation of pancreas and/or kidney transplantation patients: initial experience. Magn Reson Imaging 19:595–607
Corry RJ, Nghiem DD, Schulak JA, et al. (1986) Surgical treatment of diabetic nephropathy with simultaneous pancreatic duodenal and renal transplantation. Surg Gynecol Obstet 162:547–555
Dobos N, Roberts DA, Insko EK, et al. (2005) Contrast-enhanced MR angiography for evaluation of vascular complications of the pancreatic transplant. Radiographics 25:687–695
Hagspiel KD, Nandalur K, Pruett TL, et al. (2007) Evaluation of vascular complications of pancreas transplantation with high-spatial-resolution contrast-enhanced MR angiography. Radiology 242:590–599
Goodman J, Becker YT (2009) Pancreas surgical complications. Curr Opin Organ Transplant 14:85–89
Troppmann C (2010) Complications after pancreas transplantation. Curr Opin Organ Transplant 15:112–118
Tan M, Di Carlo A, Stein LA, et al. (2001) Pseudoaneurysm of the superior mesenteric artery after pancreas transplantation treated by endovascular stenting. Transplantation 72:336–338
Khan TF, Ciancio G, Burke GW 3rd, et al. (1999) Pseudoaneurysm of the superior mesenteric artery with an arteriovenous fistula after simultaneous kidney-pancreas transplantation. Clin Transplant 13:277–279
Paduch DA, Conlin M, Dematos A, et al. (2000) Arterial duodenovesical fistula after simultaneous pancreas and kidney transplantation. J Urol 164:1296
Green BT, Tuttle-Newjall J, Suhocki P, et al. (2004) Massive gastrointestinal hemorrhage due to rupture of a donor pancreatic artery pseudoaneurysm in a pancreas transplant patient. Clin Transplant 18:108–111
Fujita S, Fujikawa T, Mekeel KL, et al. (2006) Successful endovascular treatment of a leaking pseudoaneurysm without graft loss after simultaneous pancreas and kidney transplantation. Transplantation 82:717–718
Lall CG, Sandrasegaran K, Maglinte DT, et al. (2006) Bowel complications seen on CT after pancreas transplantation with enteric drainage. AJR 187:1288–1295
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This project was performed at Department of Radiology and Imaging Sciences, Indiana University School of Medicine.
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Liu, Y., Akisik, F., Tirkes, T. et al. Value of magnetic resonance imaging in evaluating the pancreatic allograft transplant complications. Abdom Imaging 40, 2384–2390 (2015). https://doi.org/10.1007/s00261-015-0408-x
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DOI: https://doi.org/10.1007/s00261-015-0408-x