Contrast-Enhanced MR Angiography After Pancreas Transplantation: Normal Appearance and Vascular Complications

ancreatic transplantation is increasingly used for the treatment of type 1 diabetes mellitus [1]. It commonly is performed in conjunction with kidney transplantation. The original procedure is the systemic bladder drainage type, which consists of intraperitoneal placement of the whole pancreas into the pelvis and anastomosis of the transplanted splenic and superior mesenteric arteries to the recipient’s iliac arteries via a Y-graft formed from the donor’s common, internal, and external iliac arteries. Pancreatic venous outflow with this type of graft is into the iliac veins and therefore the systemic circulation (Figs. 1 and 2). Drainage of the exocrine secretions is into the urinary bladder using an interposition duodenal segment. This technique has a number of drawbacks: namely, the development of peripheral hyperinsulinemia due to venous drainage of the insulin into the systemic circulation rather than the portal vein. This condition has been found to accelerate the development of insulin resistance and possibly atherosclerosis. In addition, urinary tract infections and graft pancreatitis occur as complications of the drainage of the exocrine secretions into the urinary bladder, necessitating conversion from bladder to enteric drainage in a substantial number of patients. These drawbacks led to the development of a modified form of pancreatic transplantation, commonly referred