Comparison of color Doppler ultrasonography and computed tomography angiography (CTA) and computed tomography venography (CTV) in the diagnosis of arteriovenous thrombosis after simultaneous pancreas-kidney transplantation: a retrospective diagnostic accuracy study.

BACKGROUND

Simultaneous pancreas-kidney transplantation is an important treatment approach for diabetic renal insufficiency, but pancreatic arteriovenous thrombosis is among the early serious surgical complications that can lead to graft loss and even be fatal. Ultrasound is considered to be a safe and non-invasive approach, but it is often affected by intestinal gas interference and operator proficiency, partial thromboses may be easily missed. Computed tomography angiography (CTA) and computed tomography venography (CTV) are highly accurate but radiative, requiring the use of contrast agents.

METHODS

A total of 194 patients with end-stage diabetic nephropathy who underwent simultaneous pancreas-kidney transplantation from September 2016 to May 2021 were selected, among which 32 patients with highly suspected arteriovenous thrombosis were enrolled as the research subjects. All patients were examined by color Doppler ultrasonography, CTA and CTV. CTA and CTV are the gold standard for diagnostic imaging. The diagnostic value of color Doppler ultrasound, CTA and CTV in the diagnosis of pancreatic arteriovenous thrombosis was compared. and Kappa coefficient was used for consistency test.

RESULTS

Among the 32 patients with high clinical suspicion of transplanted pancreatic arteriovenous thrombosis after simultaneous pancreas-kidney transplantation, 9 patients were diagnosed by CTA/CTV and 10 patients were diagnosed by color Doppler ultrasonography, of which 2 cases were false positive and 1 case false negative. After transplantation, the normal diameter of the donor splenic vein was 3.96±0.16 mm. The difference in the diameter of the donor splenic vein between those with and without donor splenic vein thrombosis was statistically significant (P<0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of color Doppler ultrasound in the diagnosis of arteriovenous thrombosis were 88.9%, 91.3%, 90.6%, 80%, and 95.5%, respectively. There was no significant difference between color Doppler ultrasound diagnosis of arteriovenous thrombosis and CTA and CTV results (McNemar test P=1). The diagnosis of arteriovenous thrombosis by color Doppler ultrasonography was consistent with that of CTA and CTV (Kappa coefficient =0.776).

CONCLUSIONS

Color Doppler ultrasonography has the advantages of safety and radiation-free, and can be used as the first choice for diagnosis of pancreatic arteriovenous thrombosis after simultaneous pancreas-kidney transplantation.