Learning objectives
Recognize the normal appearance of a kidney transplant in the early and late phases.
Discuss the vascular and non-vascular complications of renal transplantation,
occurring in the early and late phases.
Review the role of interventional radiology in managing renal transplant complications.
Background
Over the years,
renal transplantation has become the treatment of choice in end-stage renal disease,
with improved patient survival and better quality of life.
The radiologic appearance and potential postoperative complications are related to the surgical procedure.
Careful understanding of the different surgical procedures is mandatory to recognize and understand the potential complications.
Generally,
the kidney is grafted in patient’s right or left iliac fossa with end-to-side anastomosis to the external iliac vessels.
The arterial anastomosis relies on the type of graft Fig. 1 :...
Findings and procedure details
A-Vascular complications
Occur in less than 10% of kidney transplantations but remain a major cause of graft dysfunction [1].
Althoughangiography is the gold standard technique to evaluate these complications,
Doppler-ultrasound (US) offers an excellent noninvasive modality whether in the early or late postoperative period.
A-1-Renal artery stenosis Fig. 2 Fig. 3 :
-Reported in up to 10% of kidney transplantations [2].
-Occurs in the first year following transplantation [3].
-Alerting symptoms are severe hypertension refractory to medical treatment,
audible bruit over the graft or unexplained...
Conclusion
Renal transplantation is nowadays the most effective treatment in end stage renal disease.
Despite continuous improvement of surgical techniques and post-transplant management,
numerous complications can occur in a significant proportion of cases,
whether in the early or delayed post-operative period Fig. 18 .
Different imaging modalities – mainly Doppler ultrasound – play a critical role in the diagnosis and treatment of these complications.
References
1- Hohnke C,
Abendroth D,
Schleibner S,
Land W.
Vascular complications in 1200 kidney transplantations.Transplantation Proceedings.1987;19(5):3691–3692.
2- Jordan ML,
Cook GT,
Cardella CJ.
Ten years of experience with vascular complications in renal transplantation.J Urol.1982;128:689–692
3- Akbar,
S.A.,
Jafri,
S.Z.,
Amendola,
M.A.,
Madrazo,
B.L.,
Salem,
R.,
Bis,
K.G.Complications of renal transplantation.Radiographics.2005;25:1335–1356.
4- Rees CR,
Palmaz JC,
Becker GJ,
et al.Palmaz stent in atherosclerotic stenoses involving the ostia of the renal arteries: preliminary report of a multicenter study.Radiology1991;181:507–514.
5- Dodd GD,
Tublin ME,
Shah A,
Zajko AB....