Sonographic evaluation of acute pancreatic transplant rejection: morphology-Doppler analysis versus guided percutaneous biopsy.

OBJECTIVE Despite the increasing success of pancreatic transplantation for diabetes, rejection remains the most common cause of graft loss. The purpose of this study was to correlate gray-scale sonographic morphology and Doppler resistive index (RI) with acute pancreatic transplant rejection as determined by percutaneous, sonographically guided biopsy of the pancreas. SUBJECTS AND METHODS Fifty-one sonograms of 36 patients were correlated with sonographically guided biopsies performed for clinically suspected acute rejection. Sonographic studies consisted of gray-scale morphologic assessment of gland size, texture, marginal definition, peripancreatic fluid, and duct dilatation as well as measurement of the average Doppler RI. Biopsies were performed within 48 hr of sonography. After localization by sonography, we performed percutaneous biopsy with an 18-gauge automated biopsy device. RESULTS Biopsy findings were acute rejection (n = 40, 78%), chronic rejection (n = 2, 4%), and no evidence of rejection (n = 9, 18%). Procedure-related hemorrhage occurred in one patient and resolved spontaneously. Gray-scale sonographic abnormalities were present in 37 studies (73%). The most common abnormality was pancreatic enlargement (n = 23) with a sensitivity and specificity of 58% and 100%, respectively, for acute rejection. Loss of marginal definition occurred in nine studies with a sensitivity and specificity of 15% and 73%, respectively, for acute rejection. An RI > or = 0.7 was found in 11 studies (22%) with a sensitivity of 20% and a specificity of 73% for acute rejection. CONCLUSION For the diagnosis of acute pancreatic rejection, sonographically guided percutaneous biopsy is superior to gray-scale and spectral Doppler sonography. Sonographically guided percutaneous biopsy is a safe technique with a high success rate. Gray-scale and spectral Doppler sonography lack sensitivity, and a normal RI should not delay biopsy.

[1]  J. Papadimitriou,et al.  Histologic grading of pancreas acute allograft rejection in percutaneous needle biopsies. , 1996, Transplantation Proceedings.

[2]  C. Alpers,et al.  Use of ultrasound and cystoscopically guided pancreatic allograft biopsies and transabdominal renal allograft biopsies: safety and efficacy in kidney-pancreas transplant recipients. , 1995, The Journal of urology.

[3]  R. Stratta,et al.  Patterns of rejection after combined pancreas-kidney transplantation. , 1994, Transplantation Proceedings.

[4]  J. Lowell,et al.  Pancreas transplants: efficacy of US-guided cystoscopic biopsy. , 1994, Radiology.

[5]  R. Stratta,et al.  Improved technique for transduodenal pancreas transplant biopsy. , 1994, Transplantation.

[6]  A. Gaber,et al.  Percutaneous biopsy of pancreas transplants. , 1992, Transplantation.

[7]  H. Bensadoun,et al.  Is urinary amylase a reliable index for monitoring whole pancreas endocrine graft function? , 1992, Transplantation proceedings.

[8]  H. Sanfey,et al.  Pancreatic transplant rejection: evaluation by duplex-Doppler ultrasound with urinary amylase monitoring correlation. , 1992, Transplantation proceedings.

[9]  J. Chapman,et al.  PERCUTANEOUS BIOPSY OF BLADDER‐DRAINED PANCREAS TRANSPLANTS , 1991, Transplantation.

[10]  C. Kuni,et al.  Pancreatic transplantation: radiologic evaluation of vascular complications. , 1991, Radiology.

[11]  M. Bernardino,et al.  Pancreatic transplants: CT-guided biopsy. , 1990, Radiology.

[12]  J. Chapman,et al.  Percutaneous pancreas transplant fine needle aspiration and needle core biopsies are useful and safe. , 1990, Transplantation proceedings.

[13]  C. Marsh,et al.  Safety and efficacy of cystoscopically directed biopsy in pancreas transplantation. , 1990, Transplantation proceedings.

[14]  J. Perkins,et al.  Differential diagnosis of hypoamylasuria in pancreas allograft recipients with urinary exocrine drainage. , 1990, Transplantation.

[15]  G. Tydén,et al.  Duplex-Doppler ultrasonography for evaluating pancreatic grafts. , 1990, Transplantation Proceedings.

[16]  M. Wolverson,et al.  Pancreatic transplant rejection: assessment with duplex US. , 1989, Radiology.

[17]  D. J. Lubbers,et al.  Pancreatic transplants: CT with clinical and pathologic correlation. , 1989, Radiology.

[18]  W. Yuh,et al.  Pancreatic transplants: evaluation with MR imaging. , 1989, Radiology.

[19]  W. Vas,et al.  Pancreatic transplantation: scintigraphy, US, and CT. , 1988, Radiology.

[20]  K. Berbaum,et al.  Pancreatic transplant imaging. , 1988, Radiology.

[21]  L. Fernández‐Cruz,et al.  Duplex-Doppler ultrasonography in monitoring clinical pancreas transplantation , 1988, Transplant international : official journal of the European Society for Organ Transplantation.

[22]  B. Goldberg,et al.  Evaluation of renal transplant rejection by duplex Doppler examination: value of the resistive index. , 1987, AJR. American journal of roentgenology.

[23]  D. Sutherland,et al.  Pancreas transplantation: clinical considerations. , 1987, The Radiologic clinics of North America.