Pancreas Transplantation: Anatomy, Imaging, and Complications

Pancreas transplant (PT) improves quality of life and longevity in patients with diabetes by restoring endocrine function, eliminating insulin use, and reducing long-term complications. The benefits of PT must be weighed against the risks, including postsurgical complications and long-term immunosuppression. Surgical advances and improved immunosuppression regimens in the past 2 decades have led to improved patient and allograft survival rates. Imaging a PT can be challenging because of the complex postsurgical anatomy and difficulty distinguishing the PT from adjacent bowel, particularly at US. Nevertheless, US is the first-line imaging modality for evaluating the allograft and vasculature for complications. Contrast-enhanced US is a useful next step to evaluate blood flow to the allograft when Doppler US findings are inconclusive. CT with oral contrast material is preferred for evaluating suspected bowel complications and is useful for evaluating fluid collections. CT angiography is a rapid way to evaluate vasculature and bleeding complications if iodinated contrast material is not contraindicated. MRI can be used as a problem-solving tool to further evaluate complications, particularly when iodinated contrast material is contraindicated or radiation risk is a concern. Ferumoxytol-enhanced MRI is advantageous for evaluating transplant vasculature because of the prolonged intravascular state of the contrast material. It is important for radiologists to understand the spectrum of normal imaging appearances of the pancreas allograft, as well as various posttransplant complications, to provide optimal care. The authors discuss surgical techniques and the anatomy of PT, review imaging evaluation, and describe complications. ^©RSNA, 2025 Supplemental material is available for this article.