Monitoring of Pancreas-Graft Perfusion by Radionuclide and Digital Subtraction Angiography

The vascularity of a kidney transplant can be evaluated by intravenous radionuclide angiography. A normal functioning transplant should have an isotope histogram with a well-defined peak. Accordingly, a transplanted pancreas may be evaluated in the same way. By intravenous digital subtraction angiography and small amounts of contrast medium, arterial and venous structures can be visualized without catheterization of the arterial system. Five patients had combined kidney and pancreas transplantation. Intravenous angiography with ^99mTc-pertechnetate was performed three times a week for the first 5 postoperative wk. Digital subtraction angiography with an intravenous bolus of 80 ml of a low-osmolar nonionic contrast medium (iopamidol) was performed late in the postoperative course or when severe impairment of pancreas-graft perfusion was discovered by radionuclide angiography. One patient had two episodes and three patients one episode of rejection of both kidney and pancreas. Impairment of the pancreas-graft perfusion always preceded or was associated with deterioration of the graft function. In all patients, digital subtraction angiography demonstrated the graft vessels in sufficient detail. No thrombotic complications were observed. We conclude that these two methods can be used for monitoring the kidney and pancreas-graft perfusion. The methods may be of great value, especially in the early postoperative period, when problems with organ function are frequent and early intervention is essential.