Role of 16-multidetector computerized tomography in evaluation of graft failure risk in patients with pancreatic graft thrombosis after simultaneous pancreas and kidney transplantation.
BACKGROUND
Thrombosis of the pancreatic graft vessels is a common complication in patients after pancreas transplantation. The aim of this study was to evaluate the usefulness of 16-multidetector computerized tomography (16-MDCT) with volume rendering (VR) and maximum intensity projection (MIP) reconstruction as a predicting method of pancreatic graft loss after simultaneous pancreas and kidney transplantation.


METHODS
Within 6-8 days after combined kidney-pancreas transplantation, MDCT was performed in 60 patients. Secondary reconstructions were obtained with the application of VR and MIP algorithms. Vessel anastomosis, extra- and intrapancreatic arteries, venous morphology, and enhancement of graft's parenchyma were evaluated. The stenosis grade of pancreatic graft vessels and the areas of graft parenchyma malperfusion were evaluated.


RESULTS
Thrombosis of pancreatic graft vessels was recognized in 26 patients (43%), however only one-half of them required graftectomy. There were 17 cases of large vessel thrombosis and 9 cases of small intragraft vessel thrombosis. In 13 (86.6%) out of 15 recipients parenchymal malperfusion resulted in graft lost. It appeared that vessel narrowing >40% was a threshold for pancreatic graft loss with sensitivity and false positive values of 100% and 9%, respectively. For parenchyma nonenhancement >60% the sensitivity and false positive values of 100% and 0% were significantly associated with pancreatic graft loss (P < .0001).


CONCLUSIONS
Vascular occlusion of >40% and necrosis >60% of parenchymal volume correspond with pancreatic graft loss.
2nd Department of Clinical Radiology, Warsaw Medical University, Warsaw, Poland. Electronic address: larettagrabowska@gmail.com.
L
L
Grabowska-Derlatka
Department of General, Vascular, and Transplant Surgery, Warsaw Medical University, Warsaw, Poland.
T
T
Grochowiecki
2nd Department of Clinical Radiology, Warsaw Medical University, Warsaw, Poland.
R
R
Pacho
2nd Department of Clinical Radiology, Warsaw Medical University, Warsaw, Poland.
O
O
Rowiński
Department of General, Vascular, and Transplant Surgery, Warsaw Medical University, Warsaw, Poland.
J
J
Szmidt
D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010179:Pancreas / Q000098:blood supply* / Q000000981:diagnostic imaging; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011379:Prognosis; D012306:Risk; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging*