Imaging of whole-organ pancreas transplants

Whole pancreas transplantation is an established treatment for selected patients with diabetic nephropathy or poorly controlled diabetes. Surgical techniques vary and have evolved over the past 4 decades. Imaging evaluation of the whole-pancreas transplant should begin with an understanding of the most commonly used surgical techniques and the spectrum of postoperative complications. Ultrasonography (US) should be the first-line modality in evaluating the pancreas allograft and vasculature. Computed tomography (CT) is useful in the assessment of extra-allograft processes, particularly in ruling out abscess formation or evaluating suspected bowel complications. Magnetic resonance (MR) imaging is reserved for cases in which complete evaluation with US or CT is not possible. MR angiography can help provide an accurate assessment of vascular abnormalities. The radiologist must be familiar with the spectrum of surgical techniques and the normal postoperative imaging appearances of the whole-pancreas transplant so as to be able to recognize abnormal postoperative findings. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.322115144/-/DC1.