Keywords:
Transplantation, Haemodynamics / Flow dynamics, Grafts, Contrast agent-other, Contrast agent-intravenous, Computer Applications-3D, Ultrasound-Spectral Doppler, Ultrasound-Colour Doppler, Ultrasound, Vascular, Kidney, Contrast agents
Authors:
P. Grzelak, I. Kurnatowska, L. Stefanczyk; Łodz/PL
DOI:
10.1594/ecr2013/C-2390
Purpose
Surgical complications in the immediate post-transplant period occur in 5-10% of patients after the kidney transplant,
most of them may affect parenchymal perfusion.
One of the most serious postoperative complications are the renal artery (transplant renal artery stenosis – TRAS).
Critical TRAS defined as the stenosis greater than 70% has usually non-specific clinical manifestation.
A lower degree of stenosis (50-69%) are usually asymptomatic and therefore cause serious diagnostic difficulties.
Fig.1 Clinical manifestations of TRAS include difficulties to achieve adequate blood pressure control,
impairment of the excretory,
endocrine and homeostatic function of the transplanted kidney and thereby may lead to the development of ischemic nephropathy.
These changes are not specific for ischemic nephropathy,
hence the search for new diagnostic methods that allow for diagnosing the cause of graft dysfunction in quick and reliable manner.
Currently,
the primary imaging examination used in diagnosing of TRAS is standard ultrasound B presentation,
extended with color Doppler assessment of the flow spectrum (US-CD/PD/US-PW).
It is usually possible to assess the degree of stenosis on the basis of spectral flow in the vessels of the graft.
However,
this method has many limitations and cannot prove that TRAS is responsible for early graft dysfunction.
Administration of the contrast agent enables direct visualization,
recording and quantification of blood flow to the kidney.
The aim of this study was to analyse the changes of parenchymal CE perfusion in the kidney graft to detect TRAS in early post transplant course.