PURPOSE: We report seven cases of pancreas transplantation, first performed in Korea, in the context of postsurgical radiologic studies. MATERIALS AND METHODS: All patients with insulin-dependent diabetes mellitus received transplants from cadevaric(n=6) or living related donor(n=1). Retrospective analysis of 27 US(including 19 Duplex US), two CT, four MRi, and three scintigraphy for these patients was made with surgico-pathological correlation in five cases. RESULT:Of the seven patients, three-month graft survival was five and one-year survival was two. One patient died of abdominal abscess following surgery. US gave the valuable informations regarding the graff swelling, vascular complication, and perigraff fluid collection. RBC bleeding scan was effective of the presence or absence and location of intestinal bleeding. CT was useful in determining the extent and severity of the pancreatitis. MRI gave a little information about functional status of the grafted pancreas. CONCLUSION: The choice of appropriate imaging modalities for postsurgical work up in patients who had pacreas transplantation depends on the clinical conditions of the patients and complications suspected. Further prospective studies appear to be necessary to eatablish the interval and modality choice for early detection of the complication.
Abdominal Abscess ; Diabetes Mellitus, Type 1 ; Graft Survival ; Hemorrhage ; Humans ; Korea ; Magnetic Resonance Imaging ; Pancreas Transplantation* ; Pancreas* ; Pancreatitis ; Radionuclide Imaging ; Retrospective Studies ; Transplants

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
Adult ; Anastomosis, Surgical/methods ; Diagnostic Imaging/methods ; Drainage/methods ; Female ; Graft Rejection/pathology ; Graft Survival ; Humans ; Iliac Artery/radiography/surgery ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; *Medical Illustration ; Mesenteric Artery, Superior/radiography/surgery ; Middle Aged ; Pancreas/*blood supply/radiography ; Pancreas Transplantation/adverse effects/*methods ; Pancreatitis, Graft/etiology ; Portal Vein/radiography/surgery ; Postoperative Complications/radiography ; Postoperative Hemorrhage/etiology ; Survival Rate

Purpose: Aim of this study is to review the simultaneous pancreas and kidney transplantation (SPK) cases performed in Seoul National University Hospital for DM nephropathy patients. Methods: Medical records of the SPK recipients from April 2002 to February 2006 were reviewed and analyzed retrospectively. Results: There were 10 cases of SPK transplantation in SNUH from April 2002 to February 2006, which were composed of 8 type II DM patients and 2 type I DM patients. We experienced 1 operative mortality case and 3 acute rejection cases. All the acute rejection cases were recovered by steroid pulse therapy. We performed two graft pancreatectomy operations due to CMV infection followed by duodenal perforation and severe graft pancreatitis with pancreatic leakage. With the exception of 1 mortality case and 2 graft loss cases, all 7 patients stopped insulin and oral hypoglycemic agent and are keeping blood glucose level within normal range. Conclusion: Although patient follow-up is limited up to four years, SPK recipients are free from insulin use and show good graft functions. SPK could be a good treatment modality for insulin dependent type II DM nephropathy patients.
Blood Glucose ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Insulin ; Kidney Transplantation* ; Kidney* ; Medical Records ; Mortality ; Pancreas Transplantation ; Pancreas* ; Pancreatectomy ; Pancreatitis, Graft ; Reference Values ; Retrospective Studies ; Seoul* ; Transplants

This study was purposed to explore the correlation of regenerating Islet-derived 3-alpha(Reg3α) protein level in plasma with the diagnosis and prognosis of the gastrointestinal acute graft-versus-host disease (GI-aGVHD) after all-HSCT, 103 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were observed in our hospital from December 2011 to December 2012. Peripheral blood samples were routinely collected at 9 d before allo-HSCT, 0 d, 14 d, 28 d after allo-HSCT as well as in aGVHD and at the 1 and 4 weeks after aGVHD therapy. The plasma concentrations of Reg3α were measured by using ELISA kit. The results indicated that among the 103 patients, 17 cases never developed aGVHD symptoms (no-aGVHD), 27 cases presented with non-aGVHD associated diarrhea, 10 cases presented with isolated skin aGVHD, 17 cases developed grades I-II GI-aGVHD, 32 cases with grades III-IV GI-aGVHD. The plasma concentrations of Reg3α in group of patients with GI-aGVHD and group of non-aGVHD diarrhea were 111.5 (54.7-180.2) and 23.9 (14.5-89.5) ng/ml respectively with significant difference (P < 0.001). The plasma concentrations of Reg3α in 17 patients of grades III-IV GI-aGVHD who experienced a complete or partial response and 7 patients who had no response to therapy at 4 weeks were 137.2(51.7-205.4) and 679.4(122.3-896.8) ng/ml respectively with the significant difference (P = 0.028). All of the patients who had no response to therapy died of aGVHD associated multiple organ failure. The area under the ROC curve was 0.902 when plasma concentration of Reg3α was set at 87.73 ng/ml. The sensitivity was 81.48% and the specificity was 82.86% when the critical value was used in diagnosis of grades III-IV GI-aGVHD. The probability of grades III-IV GI-aGVHD had statistical difference above and below 87.73 ng/ml after allo-HSCT (P < 0.001). It is concluded that the increase of plasma Reg3α level after transplantation suggests the incidence of grades III-IV GI-aGVHD. The high level of plasma Reg3α protein in patients with grades III-IV GI-aGVHD after the immunosuppressive treatment for four weeks indicates a poor prognosis. The plasma concentrations of Reg3α can be used as a specific biomarker of GI-aGVHD.
Adolescent ; Adult ; Antigens, Neoplasm ; blood ; Biomarkers, Tumor ; blood ; Female ; Graft vs Host Disease ; diagnosis ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Intestinal Diseases ; diagnosis ; etiology ; Lectins, C-Type ; blood ; Male ; Middle Aged ; Pancreatitis-Associated Proteins ; Plasma ; Prognosis ; Transplantation, Homologous ; Young Adult