Reviewing the Imaging of Renal Transplant Complications
Number:27ESURABS0030
Type:Educational Electronic Presentation
Authors: Luís Maduro, Ana Coutinho Santos
Keywords:Kidney, Transplant, Abdomen, Ultrasound-Colour Doppler, Ultrasound-Spectral Doppler, CT,
SECTIONS
Educational objective

To discuss relevant pre and postsurgical urologic and vascular anatomy of renal transplantation.

To evaluate the transplanted kidney for potential complications or rejection.

To review the imaging features of renal transplantation complications (Doppler-US and CT findings).


Topic Review

Background

The treatment of choice for patients with end-stage renal disease is renal transplantation. Despite improvements in peritoneal dialysis and hemodialysis, these patients survive much longer after receiving a kidney transplant. Survival rates have also improved because of refined surgical techniques and more effective immunosuppression.

 

Surgical Technique

It's important to analyze the donor kidneys and the recipient before the procedure, as well as to know the surgical techniques and the postsurgical anatomic relationships.

The transplanted kidney is usually placed extraperitoneally in the patient’s right or left iliac fossa, with end-to-side anastomosis to the external iliac...

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Figure 1 – Normal Doppler-US of a kidney graft. Color Doppler image showing homogenous vascularity of the graft (A). Normal low-resistance waveforms (resistive index <0.8) can be seen in an arcuate artery (B). The renal vein (C) and the renal artery (D) also show a normal waveform.
Figure 2 – Hematoma (A and B): two perpendicular US grayscale images show a small, crescentic, heterogenous peri-renal post-transplant sub-acute hematoma. Lymphocele (C and D): two perpendicular US grayscale images depict a round fluid collection, with no internal echoes or septations.


Conclusions

Developments in the surgical techniques and more sophisticated immunosuppressive drugs have improved the survival of patients and renal grafts.

Several complications can occur over the timeline of renal transplantation, and imaging techniques have a critical role to detect them.

The aim of the radiologist is to minimize complications by a strict pre-operative evaluation and to provide the early diagnosis of complications through the interpretation of post-transplant examinations.

 

References

Mark D. Sugi et al. IMAGING OF RENAL TRANSPLANT COMPLICATIONS THROUGHOUT THE LIFE OF THE ALLOGRAFT: COMPREHENSIVE MULTIMODALITY REVIEW. Radiographics; Vol. 39, No 5. doi:10.1148/rg.2019190096

Syed A. Akbar et al. COMPLICATIONS OF RENAL TRANSPLANTATION. Radiographics; Vol. 25, No 5....

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