2023 ARRS ANNUAL MEETING - ABSTRACTS

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E2067. A Resident Primer on Simultaneous Pancreas and Kidney Transplantation
Authors
  1. Christopher Yao; University of Illinois College of Medicine
  2. Ana Gonzalez; University of Illinois Hospital and College of Medicine
  3. Eric Cooper; University of Illinois Hospital and College of Medicine
  4. Omair Ali; University of Illinois College of Medicine
  5. Bilal Hai; University of Illinois Hospital and College of Medicine
  6. Karen Xie; University of Illinois Hospital and College of Medicine
Background
Patients with insulin dependent Diabetes Mellitus and chronic kidney disease suffer from increased morbidity and mortality. Simultaneous pancreas and kidney (SPK) transplantation has been shown to significantly improve quality of life as well as life expectancy in these patients. Routine imaging during postoperative management is important for the early detection of potential complications.

Educational Goals / Teaching Points
Characterizing post-treatment imaging findings is crucial to determine future treatment.This exhibit will review the surgical technique and the anatomy of SPK transplantation, detail imaging techniques for postoperative evaluation of transplanted grafts, detail normal postoperative imaging findings, and summarize the most common postoperative complications following SPK along with their associated radiologic findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
SPK transplantation involves pancreatic and renal graft construction using donor vessels which are then anastomosed to the recipient vasculature. Neoureterocystostomy and duodenal-enterostomy are typically performed as well to attach the donor ureter and provide exocrine drainage respectively. Grayscale and Doppler ultrasound is the most commonly used imaging modality with high sensitivity for identifying graft-related complications. Other imaging modalities like computed tomography (CT), magnetic resonance imaging (MRI), and angiography have advantages and can be useful in identifying certain complications. Common vascular complications include arterial/venous stenosis, thrombosis, pseudoaneurysms, and arteriovenous fistulas. Common non-vascular complications include pancreatic graft rejection, graft pancreatitis, enteric complications, renal transplant rejection, acute tubular necrosis, acute pyelonephritis, transplant renal masses, and post-transplant lymphoproliferative disorder.

Conclusion
Simultaneous pancreas and kidney transplantation has become more common with longer post-transplant patient survival. It is paramount for radiologists to become familiar with the surgical procedure and understand the appropriate postoperative imaging management. Understanding normal graft imaging appearance and early detection of graft-related complications is important to direct management and improve outcomes in these patients.