Pancreas-kidney transplantation

Keven K, Basu A, Tan HP, Thai N, Khan A, Marcos A, Starzl TE, Shapiro R. Cytomegalovirus prophylaxis using oral ganciclovir or valganciclovir in kidney and pancreas-kidney transplantation under antibody preconditioning. Transplant Proc 2004 36(10) 3107-12. 

Odorico JS, Pirsch JD, Knechtle SJ, D Alessandro AM, Sollinger HW. A study comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney transplantation. Transplantation 1998 66(12) 1751-9. 

Bunnapradist S, Cho YW, Cecka JM, Willdnson A, Danovitch GM. Kidney allograft and patient survival in type I diabetic recipients of cadaveric kidney alone versus simultaneous pancreas kidney transplants a multivariate analysis of the UNOS database. J Am Soc Nephrol 2003 14 208-13. 

Fig.7.3a,b. A 53-year-old man after simultaneous pancreas-kidney transplantation. (CIA Common iliac artery, d donor s, ElA external iliac artery, llA internal iliac artery, IPDA inferior pancreaticoduodenal artery, r right, RA renal artery, RV renal vein, SA splenic artery, SMA superior mesenteric artery), a Angiogram obtained 31 months after operation shows normal posttransplant arterial anatomy with right-sided pancreatic and left-sided renal graft, b Maximum-intensity-projection reconstruction of contrast-enhanced MR imaging obtained 47 months after operation with normal posttransplant arterial anatomy... 

Fig. 7.6. A 28-year-old man image obtained 3 weeks after simultaneous pancreas-kidney transplantation with systemic venous drainage. 3D volumerendering display of contrast-enhanced MDCT during dominant venous phase shows normal posttransplant venous anatomy. (CIV Common iliac vein, d donor s, IVC inferior vena cava, PV portal vein, r right, RV renal vein.) Annotations pancreatic graft (arrow), renal graft (black asterisk)...

Fig. 7.8. A 42-year-old man image obtained 7 days after simultaneous pancreas-kidney transplantation. Small bowel follow-through examination with water-soluble contrast material shows duodenojejunostomy (single arrow) and partly contrasted donor s duodenum (arrowheads). Contrast-filled small bowel loops and partially air-filled descending colon indirectly outline pancreas graft. Also seen are radioopaque cutaneous staples (double arrows) resulting from median laparotomy...

Fig. 7.14a,b. A 43-year-old woman with abdominal discomfort image obtained 12 days after simultaneous pancreas-kidney transplantation, a, b Contrast-enhanced multidetector CT displays acute thrombosis of superior mesenteric vein (arrowheads) and splenic vein (arrowhead) but homogeneous contrast enhancement of pancreatic graft (arrow) with donor s duodenum (arrows) and renal graft (asterisk). (CIA common iliac artery, CIV common iliac vein, d donor s, IPDA inferior pancreaticoduodenal artery, / left, r right, SA splenic artery, SMA superior mesenteric artery)... 

Fig. 7.16. Image from a 44-year-old man obtained 9 months after simultaneous pancreas-kidney transplantation with graft necrosis but without local infection or sepsis and subsequent graft extirpation. Contrast-enhanced multidetector CT shows absent parenchymal enhancement and emphysematous transformation of pancreatic graft arrow) consistent with innocuous gas collection. Annotation renal graft black asterisk) and ascites white asterisk)...

Fig. 7.17. Image from a 33-year-old man obtained 20 months after simultaneous pancreas-kidney transplantation with pancreatic graft dysfunction and acute rejection verified by histopathological examination. Helical CT is used for image-guided percutaneous biopsy arrows) of pancreatic graft arrow) adjacent to contrast-medium-filled small bowel arrowhead) and renal graft asterisk)...

Pseudothrombosis of the iliac vein (Fig. 7.28) has been described following simultaneous pancreas-kidney transplantation with bilateral revascularization to the respective iliac vessels (Gupta et al. 2002). Pseudothrombosis results from delayed venous opacification of the iliac vein ipsilateral to the pancreatic graft as compared to the contralateral side of the renal graft. This phenomenon results from longer transit time and reduced blood flow to the pancreas as compared to the kidney. Pseudothrombosis can also involve the ipsilateral iliac vein below the vascular anastomoses of the pancre-... 

Fig. 7.19. Image from a 51-year-old man obtained 4 weeks after simultaneous pancreas-kidney transplantation. Contrast-enhanced multidetector CT shows edematous swelling of donor s remaining mesenteric fat (arrows) and lymph nodes (white asterisk) attached to unremarkable, homogeneous contrast-enhancing pancreatic graft (arrow). Condition presumably results from ligature of donor s lymphatic vessels. CT also shows normal enhancement of donor s (d) vessels including superior mesenteric artery (SMA), external iliac artery (EIA), splenic artery (SA) and renal graft (black asterisk)...

Fig. 7.20. Image from a 38-year-old man obtained 5 weeks after simultaneous pancreas-kidney transplantation with necrotizing graft pancreatitis and subsequent graft extirpation. Contrast-enhanced helical CT displays remnants of contrast-enhanced pancreatic graft (arrow) surrounded by fluid and thin-walled membrane (arrowhead) representing pseudocyst formation due to necrotizing pancreatitis. Ascites (white asterisk) and renal graft (black asterisk) are also seen...

Fig. 7.21. Image from a 54-year-oldman obtained 5 months after simultaneous pancreas-kidney transplantation with graft pancreatitis and pseudocyst formation. Sonography shows large, partly septated cyst (white asterisk) adjacent to pancreatic graft (not shown) consistent with peripancreatic pseudocyst...

Fig. 7. 25. Image from a 29-year-old man obtained 3 weeks after simultaneous pancreas-kidney transplantation with infected peripancreatic pseudocyst and complex pancreatic-cutaneous fistula. Drainage catheter (arrows) was placed through a cutaneous fistula opening, and sonogram displays large central cavity (arrow) with communication to peritoneal cavity (black arrowhead) and sinus tracts (white arrowhead) in retroperitoneal location...

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