E5424. Pancreatic Transplant and Posttransplant Complications: An Institutional Multimodality Case-Based Review
  1. Zohaib Khan; SUNY Upstate Medical University
  2. Kevin Hu; SUNY Upstate Medical University
  3. Keisha Warn; SUNY Upstate Medical University
  4. Refkey Nicola; SUNY Upstate Medical University
Pancreatic transplantation has emerged as a definitive therapeutic option for patients with end-stage pancreatic dysfunction, particularly those with diabetes mellitus and chronic pancreatitis. Pancreatic transplantation involves the replacement of a dysfunctional pancreas with a healthy donor pancreas, often accompanied by kidney transplantation (simultaneous pancreas-kidney transplant) to treat diabetes-associated renal complications. Accurate preoperative assessment, intraoperative guidance, and postoperative surveillance are essential for achieving successful outcomes. Radiologists need to be familiar with the normal posttransplant anatomy to accurately identify abnormalities. The graft pancreas is typically placed in the right lower abdomen, with vascular anastomoses to the iliac vessels. The vascular and enteric anastomoses, along with the position of the graft kidney in simultaneous pancreas-kidney transplants, must be clearly visualized and assessed for patency and complications. A range of complications can arise following pancreatic transplantation, necessitating vigilant radiologic monitoring. These include vascular complications (thrombosis, stenosis), graft rejection, surgical complications (leakage, abscess), infection, and lymphoceles. Radiologic evaluation plays a key role in diagnosing and characterizing these complications, guiding interventions and treatment strategies.

Educational Goals / Teaching Points
Discuss the epidemiology, indications, and overview of complications of pancreatic transplant. Review relevant anatomy and surgical techniques of transplant with original illustrations. Explore posttransplant complications using a multimodality case-based review including ultrasound, CT, and angiographic images from our institution. Complications to be reviewed include vascular and nonvascular etiologies, including abscess, small bowel obstruction, pseudoaneurysm, acute pancreatitis, and vasculo-enteric fistula. Introduce an overview of pancreatic transplant complication therapies and subsequent outcomes for transplant patients. Present a unique case of vasculo-enteric fistula secondary to acute transplant pancreatitis, presenting as massive gastrointestinal bleeding.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will discuss the arterial, venous, and duodenal surgical anastomotic configurations of pancreatic transplants as it relates to radiologists’ workflow — this includes Y-grafts and SMA-to-splenic artery grafts. We will discuss various imaging modalities that are employed throughout the pre- and posttransplant process.

Radiologists play a crucial role in the comprehensive care of patients undergoing pancreatic transplantation. A sound understanding of the imaging modalities, normal posttransplant anatomy, and potential complications is essential for accurate preoperative evaluation, intraoperative guidance, and postoperative surveillance. Collaboration between radiologists, surgeons, and transplant teams is paramount in achieving successful outcomes and optimizing patient care in the realm of pancreatic transplantation.