Radiological initial treatment of vascular catastrophes in pancreas transplantation: Review of current literature

David Leiberman*, Videha Sharma, Vishwanath Siddagangaiah, Edward Lake, David van Dellen, Raman Dhanda, Titus Augustine, Dare Seriki, Rajinder Singh

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Arterio-enteric fistula (AEF) is a rare but potentially devastating complication of solid organ pancreatic transplantation. Traditional management has been to remove the pancreas-duodenum allograft and control the vascular defect. Interventional radiological (IR) techniques present a new method of managing AEF related haemorrhage without re-operation and the potential to preserve graft function. This paper examines the available literature to assess efficacy and safety of this novel approach. Methods: Aggregate results tables were constructed from 28 cases identified in the English language literature where IR was used in the management of AEF following pancreas transplantation. Outcomes recorded were death, re-bleeding, surgical intervention required and post intervention graft function. These were analysed with respect to technical factors and graft function at time of presentation. Results: 28 cases of AEF managed by IR methods were identified. Mortality was high at 17.9%. 78.6% of all AEFs were present in failed pancreas allografts. Median time from transplant to bleeding event was 29 months. There was a trend of bleeding event occurring within 12 months of allograft failure or rejection. Of the AEFs present in functioning grafts, graft salvage rate was 33% from available data. Coil embolization or use of haemostatic compressed sponge as primary intervention was associated with a higher rate of re-bleeding and death versus arterial stenting. Arterial stenting resulted in a higher rate of distal ischaemia requiring surgical re-vascularisation. All deaths occurred in patients who did not have a transplant pancreatectomy as part of their definitive treatment. Conclusion: IR can be an effective way to manage bleeding in the context of AEF associated with pancreas transplantation. If patient condition allows, it should be the first-choice intervention to manage AEF associated bleeding. Use of arterial stenting is more effective in controlling and preventing further bleeding. In a non-functioning graft, transplant pancreatectomy should be strongly considered, possibly in conjunction with or following arterial stenting.

Original languageEnglish
Article number100624
JournalTransplantation Reviews
Volume35
Issue number3
Early online date18 Apr 2021
DOIs
Publication statusPublished - 1 Jul 2021

Keywords

  • Arterio-enteric
  • Fistula
  • Interventional
  • Pancreas
  • Radiology
  • Transplant

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