**7.4. Monitoring of vascular thrombosis**

Thrombosis is the most common vascular complication in the initial post-transplant (8–10 days post-transplant) period. Therefore, early diagnosis is important to establish adequate treatment.

If a first post-transplant imaging study to confirm the vascular permeability of the graft (splenic and mesenteric artery/vein) is not achieved due to bowel distention, the decision whether or not to extend the radiological procedure will be based on pancreas functionality: (1) in normal functioning graft the study is repeated in 24–48 h, (2) if dysfunctional the study is extended to a non-invasive imaging technique, such as angio-CT. Some groups advocate performing angio-CT as standard monitoring image technique due to its ability to establish a grading score for venous thrombosis [30]. In our experience, in the presence of an experienced radiologist, Doppler ultrasound, with or without contrast-enhanced ultrasound (CEUS), is a reliable screening technique.

During the first 48-h post-transplant, the patient usually stays in the intensive care unit, to be transferred later to the conventional hospital ward if there have been no adverse effects. Progressively, the oral intake is introduced and the abdominal drainage is removed. Before hospital discharge, it is important to to give a detailed description of medication and home care to the patient.
