To expose the existing surgical techniques in pancreatic transplantation. To highlight the role of the different imaging tests in graft evaluation. To make a pictorial review of the postoperative complications.

Pancreatic transplantation is an effective therapeutic option for both poorly controlled cases of insulin-dependent diabetes mellitus and patients with advanced diabetic nephropathy. Concurrent pancreas-kidney transplantation is the most commonly performed (80%). Other options include a pancreas after kidney transplant or, rarely, a pancreas transplant alone.The success of this procedure has been hindered by a historically high rate of surgical complications (30%). Knowledge of the surgical techniques, location of the anastomoses, and related complications will assist the radiologist in performing an accurate assessment that leads to...

1. Surgical techniqueThe pancreas allograft is transferred with a duodenal stump and vascular support from the donor and placed intraperitoneally in the right iliac fossa. The recipient native pancreas is left untouched. Arterial supply: superior mesenteric and splenic arteries and iliac artery bifurcation (“Y graft”). The limbs of the “Y graft” are anastomosed to the superior mesenteric and the splenic arteries of the transplanted pancreas respectively. Venous outflow: portal, splenic, and superior mesenteric veins.[Fig 1] Anastomoses: Endocrine drainage: Arterial: end-to-side anastomosis between the donor “Y...

Pancreatic transplantation is surgically challenging and is usually performed with a simultaneous renal transplantation.Different imaging techniques can assess postoperative pancreatic grafts. Ultrasound is usually the first-line imaging modality when evaluating for potential complications as well as for routine postoperative assessment. CT and MRI have been increasingly performed when ultrasound findings are equivocal.Radiologists must become familiar with the surgical techniques, location of the anastomoses, and possible related complications since an early diagnosis is crucial to ensure graft survival.

A. Berasategui Criado: Nothing to disclose C. Cantolla Nates: Nothing to disclose M. Arroyo Olmedo: Nothing to disclose S. M. Bretos Azcona: Nothing to disclose M. J. Galante Mulki: Nothing to disclose E. Julián Gómez: Nothing to disclose M. Barrios López: Nothing to disclose J. Crespo del Pozo: Nothing to disclose S. Cayón Somacarrera: Nothing to disclose

The drawings were made by Ana Berasategui Criado. França M, Certo M, Martins L, et al. Imaging of pancreas transplantation and its complications. Insights Imaging. 2010;1(5-6):329-338. doi:10.1007/s13244-010-0041-8 O'Malley RB, Moshiri M, Osman S, Menias CO, Katz DS. Imaging of Pancreas Transplantation and Its Complications. Radiol Clin North Am. 2016;54(2):251-266. doi:10.1016/j.rcl.2015.09.012 Gallego Ferrero P, Crespo Del Pozo J. Imaging in pancreas transplantation complications: Temporal classification [published online ahead of print, 2018 May 28].J Med Imaging Radiat Oncol. 2018;10.1111/1754-9485.12750. doi:10.1111/1754-9485.12750 Vandermeer FQ, Manning MA, Frazier AA, Wong-You-Cheong...