Department of Organ Transplant Surgery
Fujita Health University, school of medicine
Efficacy of contrast-enhanced ultrasonography for the prediction of the endocrine function of the graft in clinical pancreas transplantation
Naohiro Aida1, Takashi Kenmochi1, Taihei Ito1, Minoru Oshima1, Toru Nishikawa2, Mamoru Kusaka3, Kiyotaka Hoshinaga3, Hisahiro Matsubara4.
1Department of Organ Transplant Surgery, Fujita Health University, school of medicine, Toyoake, Japan; 2Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, school of medicine, Toyoake, Japan; 3Department of Urology, Fujita Health University, School of Medicine, Toyoake, Japan; 4Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
Introduction: Monitoring of blood flow of the pancreas graft is essential to detect vascular thrombus in pancreas transplantation. Doppler ultra-sonography is, however, not necessarily useful because of slow venous flow in the pancreas graft. We, previously, reported the utility of a contrast-enhanced ultrasonography (CEUS ) for the evaluation of the dynamic blood flow of the graft and detection of small vascular thrombus.
Objective: In the present study, we examined whether the data of CEUS obtained in the early period after transplantation could predict the endocrine function of the graft.
Methods: Data from 17 cases of pancreas transplantation, performed between May 2012 and March 2015 in Fujita Health University Hospital, were retrospectively assessed. CEUS was performed within 24 hours after transplantation. The time-intensity curves of the parenchyma, artery, and vein were constructed, and the time to peak (Tpeak) was calculated. The time between the Tpeak of the parenchyma and that of the vein was measured to evaluate graft microcirculation and was defined as delta-Tpeak (parenchymal pressure [PA] – portal venous pressure [PV]). ItsThe relationship between delta-Tpeak and graft endocrine function at 1 month after transplantation (HbA1c levels, 75g oral glucose tolerance test [OGTT], and glucagon test) was analyzed.
Results: The delta-Tpeak (PA-PV) in all cases was 5.80 ± 3.58 seconds (mean±SD). Two of the 17 cases experienced graft failure within 2 weeks. The delta-Tpeak in 15 cases with functioning grafts was compared with their graft function at 1 month. The delta-Tpeak showed a significant negative correlation with the C-peptide increment in the glucagon test (R2 = 0.76). The patients were divided into the following two groups depending on the value of delta-Tpeaks, ; Standard group(<7 seconds) and Delayed group (> 7 seconds). The Standard group had better glucose tolerance (glucose levelAUC in the OGTT: 711.1 ± 138.2 vs. 1013.6 ± 127.3; P = 0.014) and insulin secretion (insulin levelAUC in the OGTT: 208.7 ± 59.6 vs. 137.7 ± 29.9; P = 0.025) than those in the Delayed group. The HbA1c levels in both groups were comparable, without any significant difference (5.3% vs. 5.6%).
Conclusions: The present study demonstrated that delta-Tpeak (PA-PV) obtained in early period after transplantation was significantly correlated with the graft function at 1 month after transplantation. CEUS is useful not only for the detection of vascular thrombus, but also for the prediction of i the endocrine function of pancreas grafts.
11:00 - 12:30
|Pancreas and Islet Transplantation: Imaging, Biopsies, and Biomarkers||Efficacy of contrast-enhanced ultrasonography for the prediction of the endocrine function of the graft in clinical pancreas transplantation.||Room 110|