Pancreatic Transplant Assessment

transplantation of the pancreas can occur for several reasons, including

treating severe type 1 diabetes

— of the time, patients undergo a renal transplant at the same time

80%

two common types of transplantation techniques

exocrine bladder drainage and exocrine enteric drainage

With exocrine bladder drainage,

the vasculature of the donor pancreas is anastomosed to the recipient’s common iliac vessels and the donor duodenum is anastomosed to the urinary bladder

With exocrine bladder drainage, the recipient’s urinary bladder is

used to expel the pancreatic secretions

drawback of exocrine bladder drainage

dehydration and bladder irritation

more common type of pancreatic transplantation

exocrine enteric drainage

with an exocrine enteric drainage,

the donor’s duodenum is anastomosed to a loop of jejunum

with the exocrine enteric drainage technique, the

splenic and SMA’s are connected with the donor iliac arteries

the splenic and SMA’s are connected with the donor iliac arteries done with a exocrine enteric drainage is referred to as a

“Y” graft

with a exocrine enteric drainage, the donor common iliac portion is anastomosed to the recipient’s

common iliac artery and external iliac artery

these transplants may be located in the

RUQ or on the right side and have a vertical orientation within the body

Pancreatic transplant of the most common exocrine enteric drainage arrangement.

the pancreatic parenchyma should be

homogeneous and may be hypoechoic just after transplantation

a hypoechoic transplant may also be a sign of

pancreatitis or acute rejection

with rejection, the pancreas may also appear

heterogeneous

— are often indicative of acute rejection as well

elevated resistive indices

with chronic rejection, the pancreas can appear more

hyperechoic, atrophic, and contain calcifications

pancreatic transplant fluid collections

• abscess

• ascites

• hematoma

• urinoma (secondary to anastomosis problems at the urinary bladder)

• pseudocysts

common vascular complication that typically occurs shortly after surgery

graft thrombosis, whether arterial or venous

graft thrombosis must be suspected if — can be detected within the gland

no flow

other complications include

• pancreatitis

• arterial stenosis

• pseudoaneurysms

• fluid collections

sonographic findings of acute pancreatic transplant rejection

1. hypoechoic or heterogeneous gland

2. elevated resistive indices

pancreatic transplant vascular complications

• arterial stenosis: focal areas of increased velocities

• arterial thrombosis

• graft thrombosis

• pseudoaneurysms

• splenic vein thrombosis: elevated pulsed-wave doppler resistive index in the arterial inflow doppler waveform, often greater than 1.0; absent splenic inflow

• strictures: evident with turbulent flow

Sonographic findings of chronic pancreatic transplant rejection

1. hyperechoic echotexture

2. atrophy

3. pancreas may contain calcifications