Diagnosis of pancreatic graft rejection by duplex‐Doppler ultrasonography

Abstract

The utility of duplex-Doppler ultrasonography (US) in the diagnosis of pancreatic graft rejection was evaluated in 9 patients. The examinations assessed the resistive index (RI) of arteries within the graft parenchyma, the homogeneity and echogenicity of the parenchyma, and the presence of fluid collections around the grafts. For the first 3 days after transplantation, the RI was found to be high. Subsequently, it decreased, and when the graft was in a stable condition, the mean RI was 0.63. With acute rejection episodes, the RI increased to a mean of 0.68 (p=0.002). Thus the increase in mean RI was small but significant. If serial US examinations were performed then an increase in RI, above an individual stable base-line level, was more apparent. After successful anti-rejection treatment, the RI decreased again. In 1 case with chronic rejection, the RI was found to be high, and the parenchyma was non-homogenous with high echogenicity. With pancreatitis, the RI did not change significantly. In 2 patients, fluid collections--which later resolved spontaneously--were seen around the grafts. In 1 patient, an arterial pulsation, which had been detectable previously, was found to be absent, and arterial thrombosis was confirmed at operation. In conclusion, serial duplex-Doppler US may be useful for monitoring pancreatic grafts and the RI may assist in the diagnosis of pancreatic graft rejection.