RESUMO
Background: Biopsy of a transplanted pancreas is sometimes necessary in patients who have undergone simultaneous pancreas-kidney (SPK) transplantation and have elevated serum lipase and amylase concentrations. However, the risks associated with pancreatic graft biopsy are high, and the best biopsy technique for different location of pancreatic graft remains unclear. Methods: Depending on the anatomical location of the transplanted pancreas, percutaneous computed tomography (CT) combined with color Doppler-guided puncture biopsy or laparoscopic biopsy was used to obtain samples of transplanted pancreatic tissue that were shallow and deep, respectively. Results: After SPK transplantation, 4 patients developed abnormal serum lipase and amylase concentrations and underwent pancreas graft biopsy, 1 patient underwent percutaneous CT combined with color Doppler-guided puncture biopsy, 2 patients underwent laparoscopic wedge biopsy, and 1 patient underwent laparoscopic and puncture biopsy. All biopsies were performed successfully, with no intra- or postoperative complications (e.g., bleeding, pancreatic leakage, intestinal leakage). Biopsy sampling was effective in 3 patients, including 1 case of acute pancreatic rejection, 1 case of pancreatitis, and 1 case of pancreatic plasmablastic lymphoma. Biopsy failed to retrieve samples in 1 patient with a deep pancreatic graft who underwent laparoscopic wedge biopsy. Conclusions: Pancreas graft biopsy is safe and feasible after SPK transplantation. In addition to the two biopsy methods mentioned, other methods can also be used. Different biopsy strategies should be formulated according to the anatomical location of the transplanted pancreas.
RESUMO
Background: Simultaneous pancreas-kidney transplantation is an important treatment approach for diabetic renal insufficiency, but pancreatic arteriovenous thrombosis is among the early serious surgical complications that can lead to graft loss and even be fatal. Ultrasound is considered to be a safe and non-invasive approach, but it is often affected by intestinal gas interference and operator proficiency, partial thromboses may be easily missed. Computed tomography angiography (CTA) and computed tomography venography (CTV) are highly accurate but radiative, requiring the use of contrast agents. Methods: A total of 194 patients with end-stage diabetic nephropathy who underwent simultaneous pancreas-kidney transplantation from September 2016 to May 2021 were selected, among which 32 patients with highly suspected arteriovenous thrombosis were enrolled as the research subjects. All patients were examined by color Doppler ultrasonography, CTA and CTV. CTA and CTV are the gold standard for diagnostic imaging. The diagnostic value of color Doppler ultrasound, CTA and CTV in the diagnosis of pancreatic arteriovenous thrombosis was compared. and Kappa coefficient was used for consistency test. Results: Among the 32 patients with high clinical suspicion of transplanted pancreatic arteriovenous thrombosis after simultaneous pancreas-kidney transplantation, 9 patients were diagnosed by CTA/CTV and 10 patients were diagnosed by color Doppler ultrasonography, of which 2 cases were false positive and 1 case false negative. After transplantation, the normal diameter of the donor splenic vein was 3.96±0.16 mm. The difference in the diameter of the donor splenic vein between those with and without donor splenic vein thrombosis was statistically significant (P<0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of color Doppler ultrasound in the diagnosis of arteriovenous thrombosis were 88.9%, 91.3%, 90.6%, 80%, and 95.5%, respectively. There was no significant difference between color Doppler ultrasound diagnosis of arteriovenous thrombosis and CTA and CTV results (McNemar test P=1). The diagnosis of arteriovenous thrombosis by color Doppler ultrasonography was consistent with that of CTA and CTV (Kappa coefficient =0.776). Conclusions: Color Doppler ultrasonography has the advantages of safety and radiation-free, and can be used as the first choice for diagnosis of pancreatic arteriovenous thrombosis after simultaneous pancreas-kidney transplantation.