VENOUS THROMBOSIS OF PANCREATIC TRANSPLANTS - DIAGNOSIS BY DUPLEX SONOGRAPHY

OBJECTIVE. Our objective was to determine whether elevated pancreatic transplant arterial resistive index (RI) and absence of venous flow co rrelate with pancreatic transplant venous thrombosis. MATERIALS AND ME THODS. Thirteen episodes of surgically documented pancreatic venous th rombosis occurred in 175 pancreases that had been transplanted over a 3-year period. Duplex sonography was performed before surgical explora tion in 11 cases. We retrospectively reviewed these 11 sonograms to de termine whether blood was flowing in the veins and arteries of the gra ft. The RI was calculated from all pancreatic artery waveforms. We com pared these arterial RIs and the presence or absence of venous flow wi th those of pancreatic grafts without venous thrombosis to determine s ensitivity and specificity. RESULTS. In the venous thrombosis group, t hrombosis occurred within 12 days of transplantation (mean, 3.5 days) in all 11 cases. Six cases of thrombosis (55%) occurred within 1 day. Arterial flow was detected within the graft in nine cases (82%) and in the stump of the donor artery between the graft and the recipient ili ac artery in the two remaining cases. Antegrade diastolic flow was abs ent in all arterial tracings. Diastolic flow reversal was present in s even (78%) of nine grafts with detectable intrapancreatic arterial flo w. Arterial RIs ranged from 1.00 to 2.00 (mean +/- SD, 1.27 +/- 0.29). Intrapancreatic venous flow was absent in all 11 cases. In the contro l group (43 examinations in 34 patients) RIs ranged from 0.46 to 1.29 (mean +/- SD, 0.72 +/- 0.18). Two of 43 arterial tracings had diastoli c flow reversal (RI > 1.0). Venous flow was present in all examination s in the control group. A statistically significant difference existed between the RIs in the thrombosis group and the RIs in the control gr oup (p = .0001). CONCLUSION. Reversal of diastolic flow in pancreatic transplant arteries is highly specific for detection of graft venous t hrombosis during the first 12 days after transplantation. Our findings suggest that an RI greater than or equal to 1.00 and absence of venou s flow, in combination, are highly sensitive and specific for the diag nosis of pancreatic graft venous thrombosis.