Abstract Simultaneous kidney and pancreatic transplant is the criterion standard for treatment of end-stage renal failure because of diabetic nephropathy. Venous thrombosis occurs in approximately 5% of pancreatic transplants, and it is notoriously difficult to treat, forming the most common nonimmunologic cause of graft loss. We report a case of early detection of pancreatic graft venous thrombosis by measuring urinary amylase, resulting in the successful endovascular salvage of the pancreatic graft. Key words: Pancreas, Transplant, Endovascular Introduction Pancreatic transplant offers long-term survival for patients with type 1 diabetes, achieving rates of 85% at 1 year. 1 It is particularly valuable when managing end-stage renal failure caused by diabetic nephropathy, combined with a kidney transplant, as there is an increase in patient survival not matched by kidney transplant alone. 2,3 However, it is a difficult operation with appreciable morbidity and mortality, and these risks increase significantly after a failed pancreatic transplant. 4 Thrombosis of the pancreatic graft’s portal vein is a potentially devastating complication, being notoriously hard to treat and commonly leading to graft failure. 1,5,6 Attempts at surgical thrombectomy are often unsuccessful, 7,8 and so, medical treatment with systemic anticoagulation is sometimes recommended, especially for partial thrombosis of the pancreatic portal vein. 9,10 We describe a case of a pancreatic transplant venous thrombosis that was diagnosed early and successfully and salvaged by using interventional radiologic techniques. Case Report The patient was a 46-year-old woman with a 25-year history of type 1 diabetes mellitus. She had end-stage chronic kidney disease because of diabetic nephropathy, for which she had been on peritoneal dialysis and had been experiencing altered hypoglycemic unawareness. Comorbidities included diabetic retinopathy, controlled hypothyroidism, hypertension, hyperlipidemia, and cheiroarthropathy, which affected several joints. She had been smoking cigarettes at the time of transplant assessment, but otherwise had no risk factors for thrombosis, nor any history of thrombotic disorders. A normal dobutamine stress echocardiogram was performed 2 years before the transplant, so a cardiopulmonary exercise test was arranged after transplant assessment. This test demonstrated good cardiac reserve with an anaerobic threshold of 14.9 mL/min/kg and VO 2 heart rate response of 8 mL/beat. transplant operation A deceased-donor simultaneous kidney and pancreatic transplant was performed with the pancreas being implanted intraperitoneally in the right iliac fossa, using a donor iliac artery Y graft to the recipient's right common iliac artery. Venous drainage was by primary anastomosis from the donor’s portal vein, to the recipient’s common iliac vein, with no venous extension graft. Exocrine drainage was to the bladder. The kidney was cASe rePOrt DOI: 10.6002/ect.2012.0234 Successful Endovascular Salvage of a Pancreatic Graft After a Venous Thrombosis: Case Report and Literature Review John F. Asher, 1 Colin H. Wilson, 1 David Talbot, 1 Derek M. Manas, 1 Rob Williams, 2 Steve A. White 1 Copyright © Başkent University 2013 Printed in Turkey. All Rights Reserved. From the 1 Department of Hepatobiliary and Transplant Surgery and 2 Radiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom Corresponding author: Mr. John Asher, Consultant Transplant Surgeon, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, United Kingdom Phone: +44 141 211 1750 Fax: +44 141 211 1711 E-mail: john.asher@doctors.org.uk Experimental and Clinical Transplantation (2013) 4: 375-378