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1
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Lynch L, Chang K, Stutsrim A, Sheehan M, Edwards M. Management of dialysis access in the post-transplantation patient. Semin Vasc Surg 2024; 37:407-411. [PMID: 39675849 DOI: 10.1053/j.semvascsurg.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/10/2024] [Accepted: 10/22/2024] [Indexed: 12/17/2024]
Abstract
Arteriovenous fistula (AVF) is the preferred access for hemodialysis in patients with end-stage renal disease, and arteriovenous grafts are used when AVF creation is not feasible. Post renal transplantation, hemodialysis may be needed due to delayed graft function or transplantation failure. This review aimed to summarize current evidence on the impact of maintaining versus ligating AV access on renal function and cardiovascular outcomes post transplantation. A comprehensive review of literature was conducted, analyzing studies on the effects of AVF and AV graft maintenance or ligation on renal and cardiovascular outcomes in patients post transplantation. Evidence indicates that maintaining AVF post transplantation is associated with higher estimated glomerular filtration rate and better renal function retention, but poses risks for cardiovascular complications, such as left ventricular hypertrophy. Ligation of AVF is linked to improved cardiovascular outcomes, including reduced N-terminal pro-B-type natriuretic peptide levels, but may lead to a greater decline in estimated glomerular filtration rate. No significant difference in long-term renal allograft survival was observed between maintaining and ligating AV access. The decision to maintain or ligate AV access in patients post renal transplantation should be individualized, considering both renal function preservation and cardiovascular health. Although maintaining AVF may benefit renal function, it poses cardiovascular risks, whereas ligation can mitigate these risks without significantly affecting allograft survival.
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Affiliation(s)
- Lindsay Lynch
- Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157
| | - Kevin Chang
- Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157.
| | - Ashlee Stutsrim
- Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157
| | - Maureen Sheehan
- Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157
| | - Matthew Edwards
- Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157
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2
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D'Alessandro C, Todisco M, Di Bella C, Crimì F, Furian L, Quaia E, Vernuccio F. Surgical complications after pancreatic transplantation: A computed tomography imaging pictorial review. World J Gastroenterol 2023; 29:6049-6059. [PMID: 38130739 PMCID: PMC10731157 DOI: 10.3748/wjg.v29.i46.6049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 12/13/2023] Open
Abstract
Pancreatic transplantation is considered by the American Diabetes Association and the European Association for the Study of Diabetes an acceptable surgical procedure in patients with type 1 diabetes also undergoing kidney transplantation in pre-final or end-stage renal disease if no contraindications are present. Pancreatic transplantation, however, is a complex surgical procedure and may lead to a range of postoperative complications that can significantly impact graft function and patient outcomes. Postoperative computed tomography (CT) is often adopted to evaluate perfusion of the transplanted pancreas, identify complications and as a guide for interventional radiology procedures. CT assessment after pancreatic transplantation should start with the evaluation of the arterial Y-graft, the venous anastomosis and the duodenojejunostomy. With regard to complications, CT allows for the identification of vascular complications, such as thrombosis or stenosis of blood vessels supplying the graft, the detection of pancreatic fluid collections, including pseudocysts, abscesses, or leaks, the assessment of bowel complications (anastomotic leaks, ileus or obstruction), and the identification of bleeding. The aim of this pictorial review is to illustrate CT findings of surgical-related complications after pancreatic transplantation. The knowledge of surgical techniques is of key importance to understand postoperative anatomic changes and imaging evaluation. Therefore, we first provide a short summary of the main techniques of pancreatic transplantation. Then, we provide a practical imaging approach to pancreatic transplantation and its complications providing tips and tricks for the prompt imaging diagnosis on CT.
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Affiliation(s)
| | - Matteo Todisco
- Department of Radiology 2, University Hospital of Padova, Padova 35128, Italy
| | - Caterina Di Bella
- Department of Surgical, Kidney and Pancreas Transplantation Unit, Padova 35128, Italy
| | - Filippo Crimì
- Department of Radiology, University of Padova, Padova 35128, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, University of Padua, Padova 35128, Italy
| | - Emilio Quaia
- Department of Radiology, University of Padova, Padova 35128, Italy
| | - Federica Vernuccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo 90127, Italy
- Department of Radiology, University Hospital of Padova, Padova 35128, Italy
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Chang H, Veith FJ, Laskowski I, Maldonado TS, Butler JR, Jacobowitz GR, Rockman CB, Zeeshan M, Ventarola DJ, Cayne NS, Lui A, Mateo R, Babu S, Goyal A, Garg K. Renal transplant recipients undergoing endovascular abdominal aortic aneurysm repair have increased risk of perioperative acute kidney injury but no difference in late mortality. J Vasc Surg 2023; 77:1396-1404.e3. [PMID: 36626957 DOI: 10.1016/j.jvs.2022.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Renal transplant is associated with substantial survival advantage in patients with end-stage renal disease. However, little is known about the outcomes of renal transplant recipients (RTRs) after endovascular abdominal aortic aneurysm repair (EVAR). This study aimed to study the effect of renal transplant on perioperative outcomes and long-term survival after elective infrarenal EVAR. METHODS The Vascular Quality Initiative database was queried for all patients undergoing elective EVAR from 2003 to 2021. Functioning RTRs were compared with non-renal transplant recipients without a diagnosis of end-stage renal disease (non-RTRs). The outcomes included 30-day mortality, acute kidney injury (AKI), new renal failure requiring renal replacement therapy (RRT), endoleak, aortic-related reintervention, major adverse cardiac events, and 5-year survival. A logistic regression analysis was used to assess the association between RTRs and perioperative outcomes. RESULTS Of 60,522 patients undergoing elective EVAR, 180 (0.3%) were RTRs. RTRs were younger (median, 71 years vs 74.5 years; P < .001), with higher incidence of hypertension (92% vs 84%; P = .004) and diabetes (29% vs 21%; P = .005). RTRs had higher median preoperative serum creatinine (1.3 mg/dL vs 1.0 mg/dL; P < .001) and lower estimated glomerular filtration rate (51.6 mL/min vs 69.4 mL/min; P < .001). There was no difference in the abdominal aortic aneurysm diameter and incidence of concurrent iliac aneurysms. Procedurally, RTRs were more likely to undergo general anesthesia with lower amount of contrast used (median, 68.6 mL vs 94.8 ml; P < .001) and higher crystalloid infusion (median, 1700 mL vs 1500 mL; P = .039), but no difference was observed in the incidence of open conversion, endoleak, operative time, and blood loss. Postoperatively, RTRs experienced a higher rate of AKI (9.4% vs 2.7%; P < .001), but the need for new RRT was similar (1.1% vs 0.4%; P = .15). There was no difference in the rates of postoperative mortality, aortic-related reintervention, and major adverse cardiac events. After adjustment for potential confounders, RTRs remained associated with increased odds of postoperative AKI (odds ratio, 3.33; 95% confidence interval, 1.93-5.76; P < .001) but had no association with other postoperative complications. A subgroup analysis identified that diabetes (odds ratio, 4.21; 95% confidence interval, 1.17-15.14; P = .02) is associated with increased odds of postoperative AKI among RTRs. At 5 years, the overall survival rates were similar (83.4% vs 80%; log-rank P = .235). CONCLUSIONS Among patients undergoing elective infrarenal EVAR, RTRs were independently associated with increased odds of postoperative AKI, without increased postoperative renal failure requiring RRT, mortality, endoleak, aortic-related reintervention, or major adverse cardiac events. Furthermore, 5-year survival was similar. As such, while EVAR may confer comparable benefits and technical success perioperatively, RTRs should have aggressive and maximally optimized renal protection to mitigate the risk of postoperative AKI.
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Affiliation(s)
- Heepeel Chang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY.
| | - Frank J Veith
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Igor Laskowski
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Jonathan R Butler
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Glenn R Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Caron B Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Muhammad Zeeshan
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Daniel J Ventarola
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Neal S Cayne
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Aiden Lui
- New York Medical College, Valhalla, NY
| | - Romeo Mateo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Sateesh Babu
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Arun Goyal
- Division of Vascular and Endovascular Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
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Effect of Post-Transplant Cardiac Angiographic Procedures on Post-Transplant Renal Function. Transplant Proc 2022; 54:1822-1825. [DOI: 10.1016/j.transproceed.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022]
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5
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Doherty D, Khambalia H, Summers A, Moinuddin Z, Yiannoullou P, Krishnan A, Augustine T, Naish J, van Dellen D. Future imaging modalities for the assessment of pancreas allografts a scan of the horizon. Transplant Rev (Orlando) 2022; 36:100692. [DOI: 10.1016/j.trre.2022.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
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Liu X, Song W, Zhang X, Long F, Yin J, He X, Lv L. Downregulating LncRNA XIST attenuated contrast-induced nephropathy injury via regulating miR-133a-3p/NLRP3 axis. J Thromb Thrombolysis 2021; 52:440-453. [PMID: 33387208 DOI: 10.1007/s11239-020-02369-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Long non-coding RNA X-inactive specific transcript (LncRNA XIST) is involved in several diseases. However, the molecular mechanism of XIST and its relation with miR-133a-3p in contrast-induced nephropathy (CIN) remained vague. Sprague-Dawley (SD) rats were assigned to Control, Sham, and CIN groups at random (n = 15 for each group). Histological examination on the kidney tissues was performed using hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) staining. Mean serum creatinine (SCr) and blood urea nitrogen (BUN) contents was measured by colorimetric microplate method. Levels of inflammatory cytokines were detected by enzyme-linked immunosorbent assay (ELISA). The cells viability and apoptosis were respectively detected by MTT assay and flow cytometry. Target gene and potential binding sites between XIST, miR-133a-3p and NLR Family Pyrin Domain Containing 3 (NLRP3) were predicted using online databases and confirmed by dual-luciferase reporter assay. Relative mRNA and protein expressions of XIST, miR-133a-3p, NLRP3, apoptosis-associated speck-like protein (ASC) and Cleaved caspase-1 were measured with quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot as needed. In the rat CIN model, Ioversol induced kidney morphology changes, with increase on SCr and BUN contents, elevated levels of inflammatory cytokines and upregulated expressions of XIST, NLRP3, ASC and Cleaved caspase-1. Silencing XIST reversed the effects of Ioversol on cells. MiR-133a-3p could bind with XIST and target NLRP3, and downregulating miR-133a-3p reversed the effect of silencing XIST on Ioversol-treated cells. Moreover, downregulating XIST attenuated CIN injury via regulating miR-133a-3p/NLRP3 axis.
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Affiliation(s)
- Xingli Liu
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Wei Song
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Xiangmin Zhang
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Fangmin Long
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Junkun Yin
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Xiao He
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Liang Lv
- Department of Radiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No.157 Jinbi Road, Kunming, 650032, Yunnan, China.
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Banshodani M, Marubayashi S, Shintaku S, Sato T, Moriishi M, Tsuchiya S, Ohdan H, Kawanishi H. Percutaneous transluminal angioplasty with carbon dioxide for peripheral arterial disease after kidney transplantation: a case report with literature review. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Arteriosclerosis may progress and lead to peripheral arterial disease (PAD) during the waiting period until kidney transplantation in end-stage kidney disease (ESKD) patients. Additionally, contrast-induced nephropathy (CIN) of a kidney allograft after the examination and treatment for PAD is problematic. Here, we report the case of a kidney transplant recipient with PAD in the lower extremities who underwent percutaneous transluminal angioplasty (PTA) with carbon dioxide to prevent CIN incidence.
Case presentation
A 57-year-old woman underwent a cadaveric kidney transplant when she was 49 years old. Immunosuppression was maintained with tacrolimus, methylprednisolone, and mycophenolate mofetil. Her post-transplant course was uneventful, and serum creatinine level was maintained at 1.1–1.3 mg/dL. Intermittent claudication of the lower legs began 3 years after transplantation. Under saline intravenous rehydration, computed tomographic angiographies were performed, and the patient was diagnosed with PAD in the bilateral lower extremities. Total PTA was performed thrice for PAD in the lower extremities via a combination of carbon dioxide and iodinated contrast medium to prevent CIN incidence at 3, 4, and 7 years after kidney transplantation. The patient’s recoveries were uneventful. One year later, the serum creatinine level was maintained at 0.9–1.1 mg/dL, and since then, the patient has shown no evidence of recurrence.
Conclusions
In a kidney transplant recipient with PAD, PTA with carbon dioxide was effective to minimize the volumes of iodinated contrast medium and prevent CIN incidence.
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Kelemen JA, Kaserer A, Jensen KO, Stein P, Seifert B, Simmen HP, Spahn DR, Pape HC, Neuhaus V. Prevalence and outcome of contrast-induced nephropathy in major trauma patients. Eur J Trauma Emerg Surg 2020; 48:907-913. [PMID: 32948886 PMCID: PMC7500990 DOI: 10.1007/s00068-020-01496-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.
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Affiliation(s)
- Julian Alexander Kelemen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Kai Oliver Jensen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Philipp Stein
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute of Anesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland
| | - Burkhardt Seifert
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
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Naderi G, Azadfar A, Yahyazadeh SR, Khatami F, Aghamir SMK. Impact of the donor-recipient gender matching on the graft survival from live donors. BMC Nephrol 2020; 21:5. [PMID: 31906885 PMCID: PMC6945634 DOI: 10.1186/s12882-019-1670-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background Several factors such as recipient age, BMI, serum cratinine, and positive history of dialysis are important in predicting graft survival among kidney transplant recipients. One factor affecting the transplant outcomes is donors and recipients gender, which is usually ignored. Methods A total of 1113 kidney transplant recipients were studied in this retrospective cohort study. Several factors were taken into account for graft survival and outcomes such as donors and recipients gender and age in addition to common recipient factors like cratinine, eGFR, BMI, and positive history of dialysis. Results The most successful transplant based on donor-recipient gender was observed in male donor to male recipient, and then male donor to female recipient. In female transplant recipients, level of serum cratinine and eGFR, positive dialysis history before transplant, and low donor hemoglobin level can be considered as good prognostic factors recommended for kidney transplant survival. Conclusions Our results suggested gender matching for kidney transplant. Only in some exceptional conditions, male donor to female recipient kidney transplant may be successful and female donors to male recipients are not suggested, especially in aged patients with the history of dialysis.
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Affiliation(s)
- Gholamhossein Naderi
- Shariati Hospital, Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Azadfar
- Shariati Hospital, Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Yahyazadeh
- Shariati Hospital, Department of Urology, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Lees JS, Findlay MD, Mark PB, Geddes CC. The impact of coronary angiography on renal transplant function. QJM 2019; 112:23-27. [PMID: 30295913 DOI: 10.1093/qjmed/hcy216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION There may be reluctance to perform coronary angiography in kidney transplant patients due to perceived risk of iodinated contrast, despite an increased risk of cardiovascular disease compared with the general population. AIM We sought to determine if renal transplant function was adversely affected within 7, 30 and 180 days of coronary angiography. DESIGN AND METHODS Renal transplant recipients undergoing coronary angiography in a single centre (01/2006-02/2018) were identified retrospectively. Baseline and highest SCr within 7, 30 and 180 days of coronary angiography were extracted from the electronic patient record. Rise in creatinine >26 micromol/l was considered significant [equivalent to Acute Kidney Injury (AKI) Network criteria stage 1 AKI] and case note review performed to determine circumstance of renal decline. RESULTS There were 127 coronary angiographies conducted in 90 patients: 67.7% were male and mean age was 58.0 (±10.1) years. There was AKI within 7 days in 18.9% cases, but SCr returned to baseline within 7 days or there was an alternative explanation for AKI in 83.3% of these. In the remaining four cases, there was progressive decline in renal transplant function. In the absence of critical illness, no patient required dialysis or extended hospital stay for contrast-associated AKI. CONCLUSIONS In this cohort of renal transplant recipients undergoing coronary angiography, AKI occurred in a minority of cases, and in more than 95% of such cases this effect was transient, with progressive renal decline a rare and predictable event. Renal transplant should not be regarded as a contraindication to coronary angiography.
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Affiliation(s)
- J S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Govan Road, Glasgow, UK
| | - M D Findlay
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Govan Road, Glasgow, UK
| | - P B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Govan Road, Glasgow, UK
| | - C C Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Govan Road, Glasgow, UK
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Abstract
Proper pre- and post-transplant diagnostic imaging work-up is fundamental in ensuring a successful outcome for renal transplantation. Despite exposure to ionizing radiation, CT has high spatial resolution and is a widely available and fast imaging technique. CT is performed routinely to delineate the anatomy of the kidney, relevant vasculature, and urinary collecting system in the living donor, to assess the iliac vessels in potential recipients prior to surgery, and to assess early and late-term post-transplant complications. The purpose of this article is to outline the optimal CT protocol and the main reportable findings for both the donor and the recipient diagnostic imaging work-up as well as to point out the main issues regarding ionizing radiation exposure and contrast medium injection in these subjects.
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Benjamens S, Yakar D, Slart RHJA, Sanders JSF, Pol RA. The fear for contrast-induced nephropathy in kidney transplant recipients: time for a paradigm shift? Transpl Int 2018; 31:1050-1051. [PMID: 29761901 DOI: 10.1111/tri.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Stan Benjamens
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Stephan F Sanders
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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13
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Ranganath PG, Robbin ML, Back SJ, Grant EG, Fetzer DT. Practical advantages of contrast-enhanced ultrasound in abdominopelvic radiology. Abdom Radiol (NY) 2018; 43:998-1012. [PMID: 29332247 DOI: 10.1007/s00261-017-1442-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) are two of the workhorse modalities of abdominopelvic radiology. However, these modalities are not without patient- and technique-specific limitations that may prevent a timely and accurate diagnosis. Contrast-enhanced ultrasound (CEUS) is an effective, rapid, and cost-effective imaging modality with expanding clinical utility in the United States. In this pictorial essay, we provide a case-based discussion demonstrating the practical advantages of CEUS in evaluating a variety of pathologies in which CT or MRI was precluded or insufficient. Through these advantages, CEUS can serve a complementary role with CT and MRI in comprehensive abdominopelvic radiology.
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van der Molen AJ, Reimer P, Dekkers IA, Bongartz G, Bellin MF, Bertolotto M, Clement O, Heinz-Peer G, Stacul F, Webb JAW, Thomsen HS. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2018; 28:2845-2855. [PMID: 29426991 PMCID: PMC5986826 DOI: 10.1007/s00330-017-5246-5] [Citation(s) in RCA: 294] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022]
Abstract
Purpose The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. Areas covered in part 1 Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. Key Points • PC-AKI is the preferred term for renal function deterioration after contrast medium. • PC-AKI has many possible causes. • The risk of AKI caused by intravascular contrast medium has been overstated. • Important patient risk factors for PC-AKI are CKD and dehydration.
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Affiliation(s)
- Aart J. van der Molen
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Peter Reimer
- Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestraße 90, D-76133 Karlsruhe, Germany
| | - Ilona A. Dekkers
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands
| | - Georg Bongartz
- Department of Diagnostic Radiology, University Hospitals of Basel, Petersgaben 4, CH-4033 Basel, Switzerland
| | - Marie-France Bellin
- Service Central de Radiologie Hôpital Paul Brousse 14, av. P.-V.-Couturier, F-94807 Villejuif, France
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Strada di Fiume 447, I-34149 Trieste, Italy
| | - Olivier Clement
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20, rue Leblanc, Paris Cedex 15, F-71015 Paris, France
| | - Gertraud Heinz-Peer
- Department of Radiology, Zentralinstitut für medizinische Radiologie, Diagnostik und Intervention, Landesklinikum St. Pölten, Propst Führer-Straße 4, AT-3100 St. Pölten, Austria
| | - Fulvio Stacul
- S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, I-34129 Trieste, Italy
| | - Judith A. W. Webb
- Department of Radiology, St. Bartholomew’s Hospital, University of London, West Smithfield, London, EC1A 7BE UK
| | - Henrik S. Thomsen
- Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark
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Abu Jawdeh BG, Leonard AC, Sharma Y, Katipally S, Shields AR, Alloway RR, Woodle ES, Thakar CV. Contrast-Induced Nephropathy in Renal Transplant Recipients: A Single Center Experience. Front Med (Lausanne) 2017; 4:64. [PMID: 28603715 PMCID: PMC5445129 DOI: 10.3389/fmed.2017.00064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) in native kidneys is associated with a significant increase in mortality and morbidity. Data regarding CIN in renal allografts are limited, however. We retrospectively studied CIN in renal allografts at our institution: its incidence, risk factors, and effect on long-term outcomes including allograft loss and death. METHODS One hundred thirty-five renal transplant recipients undergoing 161 contrast-enhanced computed tomography (CT) scans or coronary angiograms (Cath) between years 2000 and 2014 were identified. Contrast agents were iso- or low osmolar. CIN was defined as a rise in serum creatinine (SCr) by >0.3 mg/dl or 25% from baseline within 4 days of contrast exposure. After excluding 85 contrast exposures where patients had no SCr within 4 days of contrast administration, 76 exposures (CT: n = 45; Cath: n = 31) in 50 eligible patients were analyzed. Risk factors assessed included demographics, comorbid conditions, type/volume of contrast agent used, IV fluids, N-acetylcysteine administration, and calcineurin inhibitor use. Bivariate and multivariable analyses were used to assess the risk of CIN. RESULTS Incidence of CIN was 13% following both, CT (6 out of 45) and Cath (4 out of 31). Significant bivariate predictors of CIN were IV fluid administration (p = 0.05), lower hemoglobin (p = 0.03), and lower albumin (p = 0.02). In a multivariable model, CIN was predicted by N-acetylcysteine (p = 0.03) and lower hemoglobin (p = 0.01). Calcineurin inhibitor use was not associated with CIN. At last follow-up, CIN did not affect allograft or patient survival. CONCLUSION CIN is common in kidney transplant recipients, and there is room for quality improvement with regards to careful renal function monitoring post-contrast exposure. In our study, N-acetylcysteine exposure and lower hemoglobin were associated with CIN. Calcineurin inhibitor use was not associated with CIN. Our sample size is small, however, and larger prospective studies of CIN in renal allografts are needed.
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Affiliation(s)
- Bassam G Abu Jawdeh
- Division of Nephrology and Hypertension, Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, OH, United States.,Cincinnati VA Medical Center, Cincinnati, OH, United States
| | - Anthony C Leonard
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Yuvraj Sharma
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, United States
| | - Swapna Katipally
- Indiana University Health Ball Memorial Hospital, Muncie, IN, United States
| | - Adele R Shields
- Division of Transplant Surgery, The Christ Hospital, Cincinnati, OH, United States
| | - Rita R Alloway
- Division of Nephrology and Hypertension, Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, OH, United States
| | - E Steve Woodle
- Division of Transplant Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Charuhas V Thakar
- Division of Nephrology and Hypertension, Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, OH, United States.,Cincinnati VA Medical Center, Cincinnati, OH, United States
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Cheungpasitporn W, Thongprayoon C, Mao MA, Mao SA, D'Costa MR, Kittanamongkolchai W, Kashani KB. Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis. World J Transplant 2017; 7:81-87. [PMID: 28280699 PMCID: PMC5324032 DOI: 10.5500/wjt.v7.i1.81] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/12/2016] [Accepted: 12/28/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the incidence of contrast-induced acute kidney injury (CIAKI) in kidney transplant recipients.
METHODS A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a random-effects model to estimate the incidence of CIAKI.
RESULTS Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6% (95%CI: 4.5%-16.3%) and 0.4% (95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0% (95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1% (95%CI: 6.6%-28.4%), 10.1% (95%CI: 4.2%-18.0%), and 6.1% (95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.
CONCLUSION The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.
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Abbas FM, Julie BM, Sharma A, Halawa A. “Contrast nephropathy” in renal transplantation: Is it real? World J Transplant 2016; 6:682-688. [PMID: 28058218 PMCID: PMC5175226 DOI: 10.5500/wjt.v6.i4.682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/26/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
The risk of contrast-induced nephropathy (CIN) in renal transplant recipients is increased in diabetics, patients with impaired basal kidney function, patients in shock, patients presenting with acute emergency and in old age recipients. Approximately one-third of all hospitalized patients with acute kidney injury is attributed to CIN. In the United States, it is the third leading cause of hospital-acquired renal failure. Therefore, efforts should be directed to minimize CIN-related morbidity and mortality as well as to shorten hospital stay. While the role of peri-procedural prophylactic hydration with saline is unequivocal; the use of acetyl cysteine is not based on robust evidence. The utility of theophylline, aminophylline, calcium channel blockers, natriuretic peptide, and diuretics does not have proven role in attenuating CIN incidence. We aim to analyze the evidence for using various protocols in published literature to limit CIN-associated morbidity and mortality, particularly during surveillance of the renal allograft survival.
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Ferrara D, Di Filippo M, Spalla F, Giribono AM, Viviani E, Santagata A, Bracale U, Santangelo M, Del Guercio L, Bracale UM. Giant true Brachial Artery Aneurysm after Hemodialysis Fistula Closure in a Renal Transplant Patient. Case Rep Nephrol Dial 2016; 6:128-132. [PMID: 27904865 PMCID: PMC5121550 DOI: 10.1159/000452299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/07/2016] [Indexed: 11/19/2022] Open
Abstract
The usual manifestation of brachial artery aneurysms is the incidental finding of a swelling of the arm, combined with paresthesia or pain in some cases. The etiology is often traumatic or secondary to drug abuse. Pathophysiology of brachial artery dilation in these cases is not completely clear. We herein describe a case of a 61-year-old male presenting with a giant, painful, pulsatile mass on his left arm. He was submitted to a cadaveric kidney transplant in 2005. He had a functioning arteriovenous fistula (AVF) on his right arm, and a spontaneously thrombosed radiocephalic AVF on his left arm. The aneurysm was surgically resected, sparing the median nerve that was totally entrapped and an inverted segment of the basilic vein interposed. At the follow-up, the patient did not present neurological or ischemic disturbs, and the vein graft maintained its patency.
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Affiliation(s)
- Doriana Ferrara
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Michele Di Filippo
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Flavia Spalla
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Maria Giribono
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Emanuela Viviani
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Annamaria Santagata
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Umberto Bracale
- Operative Unit of General Surgery, University Federico II of Naples, Naples, Italy
| | - Michele Santangelo
- Operative Unit of General Surgery & Transplants, University Federico II of Naples, Naples, Italy
| | - Luca Del Guercio
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
| | - Umberto Marcello Bracale
- Operative Unit of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy
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Incidences of acute kidney injury, dialysis, and graft loss following intravenous administration of low-osmolality iodinated contrast in patients with kidney transplants. Abdom Radiol (NY) 2016; 41:2182-2186. [PMID: 27377897 DOI: 10.1007/s00261-016-0827-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the incidence of acute kidney injury (AKI), need for emergent dialysis, and renal graft loss in patients with kidney transplants, who underwent CT examinations with low-osmolality iodine-based contrast material (IBCM). MATERIALS AND METHODS Our institutional review board approved this retrospective Health Insurance Portability and Accountability Act compliant study. From January 2005 to April 2015, a total of 224 CT examinations were performed using low-osmolality IBCM in patients with kidney transplants. Six patients who had septic or cardiogenic shock and 30 patients with documented, failed transplants were excluded from our analysis, yielding a total of 188 examinations. Of these, pre- and post-CT serum creatinine (SCr) values were available for 104 examinations, to allow evaluation of AKI. The mean baseline SCr and estimated glomerular filtration rate (eGFR) in this subgroup were 1.37 mg/dL (median 1.18, range 0.5-6.05) and 65.8 mL/min/1.73 m2, respectively (median 65, range 9-114). AKI was defined as a rise in SCr of either (a) ≥0.3 mg/dL or (b) ≥0.5 mg/dL in the 24- to 72-h period following IBCM administration. For all patients undergoing the 188 examinations, need for dialysis and graft loss 30 days after contrast administration were evaluated. RESULTS In patients with pre- and post-CT SCr values, the incidence of AKI was 7% (7/104) based on a rise of ≥0.3 mg/dL and 3% (3/104) based on a rise of ≥0.5 mg/dL. All three patients with the more strict definition (≥0.5 mg/dL) had a pre-CT eGFR <60 mL/min/1.73 m2. No patient required dialysis or had renal graft loss 30 days after contrast administration. CONCLUSION The incidence of AKI after administration of low-osmolality IBCM administration in renal transplant recipients is low, with no instances of emergent dialysis or graft loss at 30 days post contrast.
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Summaria F, Giannico MB, Talarico GP, Patrizi R. Percutaneous coronary interventions and antiplatelet therapy in renal transplant recipients. Ther Adv Cardiovasc Dis 2016; 10:86-97. [PMID: 26680559 PMCID: PMC5933627 DOI: 10.1177/1753944715622120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease is the leading cause of mortality and morbidity following renal transplantation (RT), accounting for 40-50% of all deaths. After renal transplantation, an adverse cardiovascular event occurs in nearly 40% of patients; given the dialysis vintage and the average wait time, the likelihood of receiving coronary revascularization is very high. There is a significant gap in the literature in terms of the outcomes of prophylactic coronary revascularization in renal transplantation candidates. Current guidelines on myocardial revascularization stipulate that renal transplant patients with significant coronary artery disease (CAD) should not be excluded from the potential benefit of revascularization. Compared with percutaneous coronary intervention (PCI), however, coronary artery bypass grafting is associated with higher early and 30-day mortality. About one-third of renal transplant patients with CAD have to be treated invasively and so PCI is currently the most popular mode of revascularization in these fragile and compromised patients. A newer generation drug-eluting stent (DES) should be preferred over a bare metal stent (BMS) because of its lower risk of restenosis and improved safety concerns (stent thrombosis) compared with first generation DES and BMS. Among DES, despite no significant differences being reported in terms of efficacy, the newer everolimus and zotarolimus eluting stents should be preferred given the possibility of discontinuing, if necessary, dual antiplatelet therapy before 12 months. Since there is a lack of randomized controlled trials, the current guidelines are inadequate to provide a specifically tailored antiplatelet therapeutic approach for renal transplant patients. At present, clopidogrel is the most used agent, confirming its central role in the therapeutic management of renal transplant patients undergoing PCI. While progress in malignancy-related mortality seems a more distant target, a slow but steady reduction in cardiovascular deaths, improving pharmacological and interventional therapy, is nowadays an achievable medium-term target in renal transplant patients.
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Affiliation(s)
- Francesco Summaria
- Cath-Lab/Department of Cardiology-Policlinico Casilino, Via Casilina, 1049, Rome 00199, Italy
| | | | | | - Roberto Patrizi
- Cath-Lab/Department of Cardiology-Policlinico Casilino, Rome, Italy
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Incidence of Contrast-Induced Nephropathy After Renal Graft Catheter Arteriography Using Iodine-Based Contrast Medium. AJR Am J Roentgenol 2016; 206:783-6. [PMID: 26866337 DOI: 10.2214/ajr.15.15501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of our study was to assess the incidence of contrast-induced nephropathy (CIN), dialysis, and graft loss after direct intraarterial infusion of iodine-based contrast medium (CM) in renal allograft recipients. MATERIALS AND METHODS One hundred patients underwent renal graft catheter arteriography between 2006 and 2014. CIN was defined as an increase in serum creatinine value of 0.5 mg/dL or more above the creatinine value before arteriography. CIN could be assessed in 37 patients with creatinine levels obtained before arteriography and 24-72 hours after arteriography. Dialysis requirement and renal allograft loss at 30 days after the procedure were recorded in all 100 patients. RESULTS In the 37 patients who could be assessed for CIN, three patients (8%) met the criteria for CIN. In a subgroup analysis, there was an increased incidence of CIN in patients undergoing angiography alone (25%) compared with those in the angioplasty and stenting group (0%) (p = 0.028). At 30 days after the procedure, none (0/100) of the patients required dialysis or had graft failure. CONCLUSION In a cohort of patients with a single renal allograft undergoing renal graft catheter arteriography using iodine-based CM, the overall incidence of CIN was low and no major adverse outcomes were noted at 30 days after the procedure. However, in a subgroup analysis, the patients who underwent arteriography alone-that is, without angioplasty or stenting-had a statistically significant higher rate of CIN.
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