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1
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Lakha AS, Ahmed S, Hunter J, O’Callaghan J. Prophylactic Peri-Nephric Drain Placement in Renal Transplant Surgery: A Systematic Review and Meta-Analysis. Transpl Int 2024; 37:13030. [PMID: 39155950 PMCID: PMC11327091 DOI: 10.3389/ti.2024.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/09/2024] [Indexed: 08/20/2024]
Abstract
Renal transplantation is common worldwide, with >25,000 procedures performed in 2022. Usage of prophylactic perinephric drains is variable in renal transplantation; drains are associated with risks, and there is a lack of consensus regarding benefit of routine drain placement in these patients. This meta-analysis assessed whether prophylactic drainage reduced need for reintervention postoperatively. This systematic review and meta-analysis was carried out using the Preferred Reporting Items in Systematic Reviews and Meta-Analysis, and prospectively registered on PROSPERO. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (CI) of 95% and are presented as Forest Plots for Odds Ratio (OR). A systematic literature search in June 2023 revealed 1,540 unique articles across four databases. Of these, four retrospective cohort studies were selected. Meta-analysis of three studies showed no significant reduction in reintervention rate with pre-emptive drain placement, OR = 0.59 (95% CI: 0.16-2.23), p = 0.44. Meta-analysis did not show a significant reduction in perinephric collections with prophylactic drain insertion OR = 0.55 (95% CI: 0.13-2.37), p = 0.42. Finally, there is not good evidence that drain placement reduces superficial wound complications or improves 12-month graft survival. Further work is needed, including well-designed, prospective studies to assess the risks and benefits of drain placement in these patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023422685, Identifier PROSPERO CRD42021255795.
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Affiliation(s)
- Adil S. Lakha
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | | | - James Hunter
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - John O’Callaghan
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Centre for Evidence in Transplantation, University of Oxford, Oxford, United Kingdom
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2
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des Bordes U, Hoang T, Dale BS, Sharma AK. Sclerotherapy of the Post renal Transplant Lymphoceles: A Meta-Analysis. Transplant Proc 2024; 56:316-321. [PMID: 38368131 DOI: 10.1016/j.transproceed.2024.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE This study evaluated the effectiveness of sclerotherapy in treating lymphoceles after kidney transplantation, focusing on factors such as recurrence rates and procedural success. MATERIALS AND METHODS Retrospective studies using sclerotherapy as the only form of treatment for postrenal transplant lymphoceles were included. All studies used percutaneous transcatheter sclerotherapy as treatment, and the success rate of the intervention was recorded. Sixty-one references were obtained by manually searching the MEDLINE (n = 20), Embase (n = 41), and Cochrane Library databases (n = 0) for retrospective research studies that included the keywords "sclerotherapy post renal transplant lymphoceles." After removing 3 duplicates, 50 of the remaining articles were excluded after the screening, and the remaining studies were extracted for demographic data and our primary outcome of the success rate of sclerotherapy. RESULTS A descriptive analysis of the outcomes and complication rates associated with sclerotherapy interventions for lymphoceles is provided. A high degree of variation across the different studies was observed. According to the Kruskal-Wallis test, there was no correlation between the sclerosant used and the sclerotherapy complication rate (P = .472) or the success rate (P = .591). There was also no correlation between the gender of the patient and the success rate; however, there was a significant difference in the complication rate by gender (P < .005). CONCLUSIONS In conclusion, different sclerosant products have been used for therapy with no consensus on the most efficacious product because the success rate has been variable. In addition, the gender of the patient may influence the complication rates associated with sclerotherapy for lymphoceles in patients post-kidney transplant.
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Affiliation(s)
- Ursula des Bordes
- Department of Internal Medicine, University of Rochester, Rochester, New York
| | | | - Benjamin S Dale
- Department of Surgery, University of Rochester, Rochester, New York
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3
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Rhea A, Elias H, Kamal H. Subcapsular renal transplant hematoma mimicking acute tubular necrosis. Clin Case Rep 2023; 11:e7774. [PMID: 37554576 PMCID: PMC10404795 DOI: 10.1002/ccr3.7774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 08/10/2023] Open
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. However, it is associated with serious potential complications, one of which is the subcapsular renal transplant hematoma. Ultrasound is the major imaging tools in the evaluation of early graft complications. We discuss the case of a patient who underwent a living-donor kidney transplantation, complicated of acute kidney injury documented on serial blood tests with an elevation of creatinine levels and oliguria. Ultrasonography showed the presence of a subcapsular renal hematoma, associated with the same spectral characterizations of an acute tubular necrosis with a high resistive index on Color Doppler Ultrasonography Study of renal arteries. The patient underwent an emergent surgical evacuation of the subcapsular renal hematoma. A repeat ultrasonography showed the complete resolution of the subcapsular renal hematoma with normal resistive index. During the following days, diuresis was back to normal and serial blood tests showed normal levels of creatinine. This case report highlights the importance of Ultrasonography in detecting subcapsular hematomas that could be a reversible cause of acute kidney injury and acute tubular necrosis in the setting of renal transplant.
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Affiliation(s)
- Akel Rhea
- Medical Imaging DepartmentHotel Dieu de France HospitalBeirutLebanon
| | - Haddad Elias
- Medical Imaging DepartmentHotel Dieu de France HospitalBeirutLebanon
| | - Hachem Kamal
- Medical Imaging DepartmentHotel Dieu de France HospitalBeirutLebanon
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Drudi FM, Angelini F, Bertolotto M, Granata A, Di Pierro GB, Lai Q, D'Ermo G, Pretagostini R, Cantisani V. Role of Contrast-Enhanced Voiding Urosonography in the Evaluation of Renal Transplant Reflux - Comparison with Voiding Cystourethrography and a New Classification. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e73-e80. [PMID: 33434942 DOI: 10.1055/a-1288-0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED Vesicoureteral reflux (VUR) is a common urological complication in renal transplant patients. THE AIM of this study is to evaluate the performance of contrast-enhanced voiding urosonography (CEvUS) in the diagnosis and classification of reflux into the renal allograft, to evaluate and classify VUR into the allograft using voiding cystourethrography (VCUG) and CEvUS, to compare the two methods, and to propose a new classification of reflux into the allograft based on CEvUS and VCUG assessment, in line with the international reflux grading system. MATERIALS AND METHODS From January 2017 to July 2019, 84 kidney transplant patients were enrolled. All patients underwent VCUG and CEvUS. RESULTS In 76 cases there was agreement between VCUG and CEvUS (90 %) (Kappa = 0.7). The sensitivity of CEvUS using VCUG as the gold standard was 90 %, and the specificity was 92 %. Of the 7 cases diagnosed by VCUG and not by CEvUS, 6 were grade 1 and 1 was grade 2. CONCLUSION Transplant patients with reflux symptoms should undergo CEvUS. If the outcome is negative, VCUG should be performed. The classification that we propose is better suited to describe VUR in transplant patients, because it is simpler and takes into account whether reflux occurs not only during urination but also when the bladder is relaxed.
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Affiliation(s)
| | - Flavia Angelini
- Department of Radiology, University La Sapienza, Rome, Italy
| | | | - Antonio Granata
- Nephrology and Dialysis Unit, "St. Giovanni di Dio" Hospital, Agrigento, Italy
| | | | - Quirino Lai
- Hepato-Biliary Surgery and Organ Transplantation Unit, University La Sapienza, Rome, Italy
| | - Giuseppe D'Ermo
- Department of Surgery "P. Valdoni", Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Renzo Pretagostini
- Hepato-Biliary Surgery and Organ Transplantation Unit, University La Sapienza, Rome, Italy
| | - Vito Cantisani
- Department of Radiology, University La Sapienza, Rome, Italy
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5
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Stigler J, Tiefenthaler M. Value and limitations of sonography in kidney transplant recipients with special attention to the resistive index - An update. FRONTIERS IN NEPHROLOGY 2022; 2:997839. [PMID: 37675004 PMCID: PMC10479591 DOI: 10.3389/fneph.2022.997839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 09/08/2023]
Abstract
Kidney transplantation has become the standard treatment for end-stage renal disease. Even though the success rates are high, early and late post-transplant complications remain a major clinical problem due to the risk of graft failure. Therefore, it is of highest interest to early diagnose post-transplant complications. Ultrasound with color coded Duplex analysis plays a crucial role in imaging mechanical and vascular complications. In this article, we give an update of the visualizable complications in kidney transplant recipients and discuss the value of resistive index (RI) measurement with its limitations in allograft rejection.
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Affiliation(s)
| | - Martin Tiefenthaler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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6
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Petersen KE, Hunt TM, McMenomy BP, Prieto M. Sonographic Assessment of Renal Transplant Anastomotic Pseudoaneurysm: A Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal transplant anastomotic pseudoaneurysms (RTAPs) are a rare vascular postoperative complication. The etiology of these pseudoaneurysms is attributed to infection or surgical vessel damage. RTAPs can lead to allograft dysfunction, allograft loss, or patient mortality due to rupture or sepsis. Because of these serious complications, expedient diagnosis is imperative for initiating surgical intervention and medical management. Sonography is a useful imaging modality for diagnosing and characterizing RTAPs. The sonographic findings, although not often described in detail in the literature, are definitive and unique. This case report describes the sonographic findings of a patient 22 days post renal autotransplant, who presented with excruciating abdominal pain. Sonographic examination identified multiple classic pseudoaneurysm findings and demonstrated intrarenal and extrarenal vascular abnormalities.
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Affiliation(s)
| | | | | | - Mikel Prieto
- Department of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA
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7
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Núñez F P, Castro F, Mezzano G, Quera R, Diaz D, Castro L. Hepatobiliary manifestations in inflammatory bowel disease: A practical approach. World J Hepatol 2022; 14:319-337. [PMID: 35317174 PMCID: PMC8891676 DOI: 10.4254/wjh.v14.i2.319] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/10/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBD) are associated with various hepatobiliary disorders. They can occur at any moment in the course of the disease or associated with the treatment. The prevalence of liver dysfunction can reach up to 50% in different studies. Nonalcoholic fatty liver disease is considered the most common hepatobiliary complication in IBD, while primary sclerosing cholangitis is the most specific. Management of hepatic manifestations in IBD involves a multidisciplinary approach that includes a high index of suspicion and joint management with hepatologists. The medical confrontation with abnormal liver tests must include an exhaustive study to determine if these patterns can be related to IBD, associated diseases or to the therapies used.
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Affiliation(s)
- Paulina Núñez F
- Universidad de los Andes,Inflammatory Bowel Disease Program, Digestive Disease Center, Santiago 7600976, RM, Chile
- Inflammatory Bowel Disease Program, Hospital San Juan de Dios, Universidad de Chile, Santiago 7701230, RM, Chile
| | - Fabiola Castro
- Universidad de los Andes,Hepatology Program, Digestive Disease Center, Santiago 7600976, RM, Chile
| | - Gabriel Mezzano
- Universidad de los Andes,Hepatology Program, Digestive Disease Center, Santiago 7600976, RM, Chile
- Department of Gastroenterology, Hospital del Salvador/Universidad de Chile, Santiago 7600976, RM, Chile
| | - Rodrigo Quera
- Universidad de los Andes,Inflammatory Bowel Disease Program, Digestive Disease Center, Santiago 7600976, RM, Chile
| | - Diego Diaz
- Medicine, Universidad de los Andes, Santiago 770976, RM, Chile
| | - Lorena Castro
- Universidad de los Andes,Hepatology Program, Digestive Disease Center, Santiago 7600976, RM, Chile
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8
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Malhotra D, Dahl NK. An Unusual Cause of AKI in a Kidney Transplant Recipient. KIDNEY360 2021; 2:1869-1870. [PMID: 35373005 PMCID: PMC8785853 DOI: 10.34067/kid.0004332021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Divyanshu Malhotra
- Department of Medicine, Section of Nephrology, Yale School of Medicine, Yale University, Connecticut
| | - Neera K. Dahl
- Department of Medicine, Section of Nephrology, Yale School of Medicine, Yale University, Connecticut
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9
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Luna C, Hassan F, Scortegagna E, Castillo RP. Analysis of the Peak Systolic Velocity in the Transplant Renal Artery Anastomosis to Determine Normal Values in Patients Without Graft Dysfunction. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/87564793211029897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The primary purpose is to define the mean renal artery anastomosis peak systolic velocity (RAA PSV) and the renal artery anastomosis to external iliac artery ratio (RAA-to-EIA) of renal transplant recipients without graft dysfunction. Moreover, to determine associations with type of vascular anastomosis and type of graft. Materials and Methods: This is a single-center retrospective analysis of kidney transplant recipients. Recorded variables included recipient age, type of vascular anastomosis, type of graft, RAA PSV, and external iliac artery PSV (EIA PSV). Such variables were evaluated on different postoperative follow-up periods. Results: There was a high degree of reliability between the RAA PSV and EIA PSV ( P < .001). The mean RAA PSV was 174 cm/s ± 72.9 cm/s with 95% confidence interval (CI) (162.2 cm/s-185.5 cm/s]. Conclusion: This study highlights the importance of determining the normal range of RAA PSV and showed that a high PSV does not necessarily indicate dysfunction.
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Affiliation(s)
- Cibele Luna
- Department of Radiology, University of Miami and Jackson Memorial Hospital, Miami, FL, USA
| | - Farooq Hassan
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Eduardo Scortegagna
- Department of Radiology, University of Miami and Jackson Memorial Hospital, Miami, FL, USA
| | - Rosa Patricia Castillo
- Department of Radiology, University of Miami and Jackson Memorial Hospital, Miami, FL, USA
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10
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Sjekavica I, Novosel L, Rupčić M, Smiljanić R, Muršić M, Duspara V, Lušić M, Perkov D, Hrabak-Paar M, Zidanić M, Skender M. RADIOLOGICAL IMAGING IN RENAL TRANSPLANTATION. Acta Clin Croat 2018; 57:694-712. [PMID: 31168207 PMCID: PMC6544089 DOI: 10.20471/acc.2018.57.04.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
SUMMARY – Radiological diagnostic methods have a significant role in the preoperative and postoperative care of patients after kidney transplantation. Improvement and innovations in technology, but also the growing experience of the radiologists who deal with kidney transplant patients as part of the transplant team lead to earlier detection of complications in the postoperative period, which are the leading cause of transplant failure. In this article, we describe, through diagnostic imaging examples, detailed evaluation of all possible complications that can occur after kidney transplantation, with evaluation of different possible diagnostic methods that can be used in the preoperative assessment and postoperative follow up and care of the transplanted patient. The goal of this article is to demonstrate and summarize in detail the possible complications of renal transplantation and how to best diagnostically approach them, with special reference to ultrasound which is the main imaging method for this group of conditions.
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Affiliation(s)
| | - Luka Novosel
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Melita Rupčić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ranko Smiljanić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Miroslav Muršić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vlatko Duspara
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mario Lušić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Dražen Perkov
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Maja Hrabak-Paar
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Martina Zidanić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mateja Skender
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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11
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Buttigieg J, Agius-Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J Transplant 2018; 8:142-149. [PMID: 30211022 PMCID: PMC6134271 DOI: 10.5500/wjt.v8.i5.142] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/21/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023] Open
Abstract
Urological complications, especially urine leaks, remain the most common type of surgical complication in the early post-transplant period. Despite major advances in the field of transplantation, a small minority of kidney transplants are still being lost due to urological problems. Many of these complications can be traced back to the time of retrieval and implantation. Serial ultrasound examination of the transplanted graft in the early post-operative period is of key importance for early detection. The prognosis is generally excellent if recognized and managed in a timely fashion. The purpose of this narrative review is to discuss the different presentations, compare various ureterovesical anastomosis techniques and provide a basic overview for the management of post-transplant urological complications.
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Affiliation(s)
- Jesmar Buttigieg
- Renal Division, Mater Dei Hospital, Msida MSD2090, Malta
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | | | - Ajay Sharma
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
- Department of Transplantation, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
- Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
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12
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Meier M, Fricke L, Eikenbusch K, Smith E, Kramer J, Lehnert H, Nitschke M. The Serial Duplex Index Improves Differential Diagnosis of Acute Renal Transplant Dysfunction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1607-1615. [PMID: 28370148 DOI: 10.7863/ultra.16.07032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/24/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Renal duplex sonography represents a standard noninvasive diagnostic procedure to demonstrate morphologic changes in acute kidney transplant dysfunction. We investigated whether a newly developed serial duplex index (SDI) can differentiate between acute cellular rejection and acute vascular rejection more effectively than the established Doppler parameters of the resistive index (RI) and pulsatility index (PI) in recently transplanted patients. METHODS Serial duplex scans of patients with histologically proven acute tubular necrosis (n = 25), acute cellular rejection (n = 28), acute vascular rejection (n = 18), and normal graft function (n = 50, partially protocol biopsied) were retrospectively analyzed. For each patient, the RI, PI, and cortex-pelvis proportion (CPP) were included from the day of biopsy (t0) and 3 to 7 days before biopsy (t-1). The sequential CPP ratio (CPPt0 /CPPt-1 ), RI ratio (RIt0 /RIt-1 ), and PI ratio (PIt0 /Pit-1 ) were determined. The SDI was calculated as: RI ratio × PI ratio/CPP ratio. The diagnostic accuracy of the SDI was compared with that of the RI and PI ratios. RESULTS Selected groups were statistically comparable in all routinely determined transplant parameters. The SDI was significantly different between patients with normal graft function, acute cellular rejection, and acute vascular rejection (P < .01, analysis of variance on ranks), whereas the RI and PI ratios were only significantly different between patients with normal graft function and acute vascular rejection (P < .05, analysis of variance on ranks). The indices' ranges were defined by the 95% confidence intervals between the allograft functions. CONCLUSIONS The developed SDI was able to detect acute renal transplant rejection with greater sensitivity and specificity than the RI and PI ratios. Since the SDI distinguishes between acute tubular necrosis, acute cellular rejection, and acute vascular rejection, it might be a supportive tool to indicate renal biopsy.
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Affiliation(s)
- Markus Meier
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Lutz Fricke
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
- Nephrology Center of Reinbek and Geesthacht, Reinbek, Germany
| | - Katrin Eikenbusch
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Emma Smith
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Jan Kramer
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
- LADR Zentrallabor Dr Kramer & Kollegen, Geesthacht, Germany
| | - Hendrik Lehnert
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
| | - Martin Nitschke
- Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany
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13
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Salsamendi J, Pereira K, Baker R, Bhatia SS, Narayanan G. Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience. J Radiol Case Rep 2015; 9:9-17. [PMID: 26629289 DOI: 10.3941/jrcr.v9i10.2535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt-Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment.
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Affiliation(s)
- Jason Salsamendi
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Keith Pereira
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Reginald Baker
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Shivank S Bhatia
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Govindarajan Narayanan
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
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14
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Quantified power Doppler as a predictor of delayed graft function after renal transplantation. Int Urol Nephrol 2014; 47:405-12. [DOI: 10.1007/s11255-014-0896-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/30/2014] [Indexed: 12/01/2022]
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15
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16
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Abstract
Ultrasonography is an excellent tool for evaluation of the renal transplant in the immediate postoperative period and for long-term follow-up. In this article, normal imaging findings and complications of renal transplantations are described. Disease processes are divided into vascular, perinephric, urologic and collecting system, and parenchymal abnormalities. Attention is paid to the time of occurrence of each complication, classic imaging findings, and potential pitfalls.
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Affiliation(s)
- Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
| | - Christopher P Sereni
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Mindy M Horrow
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
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17
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Inci MF, Ozkan F, See TC, Tatli S. Renal Transplant Complications: Diagnostic and Therapeutic Role of Radiology. Can Assoc Radiol J 2014; 65:242-52. [DOI: 10.1016/j.carj.2013.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 06/05/2013] [Accepted: 06/21/2013] [Indexed: 02/08/2023] Open
Abstract
Kidney was the first and is the most frequently transplanted organ. Despite improved surgical techniques and transplantation technology, complications do occur and, if left untreated, may lead to catastrophic consequences. Renal transplantation complications may be vascular (eg, renal artery and vein stenosis and thrombosis, arteriovenous fistula, and pseudoaneurysms); urologic (eg, urinary obstruction and leak, and peritransplantation fluid collections, including hematoma, seroma, lymphocele, and abscess formation); and nephrogenic, including acute tubular necrosis, graft rejection, chronic allograft nephropathy, and neoplasm. Early diagnosis and treatment of these complications are paramount to prevent graft failure and other significant morbidities to the patients. Radiology plays a pivotal role in the diagnosis and treatment of these complications, with minimally invasive percutaneous techniques. In this article, we reviewed renal transplantation anatomy, a wide range of complications that may occur after renal transplantation surgery, typical imaging appearances of the complications on varies imaging modalities, and percutaneous interventional techniques that are used in their treatment.
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Affiliation(s)
- Mehmet Fatih Inci
- Department of Radiology, Sütçü İmam University Medical School, Kahramanmaraş, Turkey
| | - Fuat Ozkan
- Department of Radiology, Sütçü İmam University Medical School, Kahramanmaraş, Turkey
| | - Teik Choon See
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Servet Tatli
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Granata A, Di Nicolò P, Scarfia VR, Insalaco M, Lentini P, Veroux M, Fatuzzo P, Fiorini F. Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do. J Ultrasound 2014; 18:109-16. [PMID: 26191098 DOI: 10.1007/s40477-014-0118-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/06/2014] [Indexed: 12/13/2022] Open
Abstract
Kidney transplantation is the treatment of choice in end-stage renal disease, given the better quality of life of transplanted patients when compared with patients on maintenance dialysis. In spite of surgical improvements and new immunosuppressive regimens, parts of transplanted grafts still develop chronic dysfunction. Ultrasonography, both in B-mode and with Doppler ultrasound, is an important diagnostic tool in case of clinical conditions which might impair kidney function. Even though ultrasonography is considered fundamental in the diagnosis of vascular and surgical complications of the transplanted kidney, its role is not fully understood in case of parenchymal complications of the graft. The specificity of Doppler is low both in case of acute complications, such as acute tubular necrosis, drugs toxicity and acute rejection, and in case of chronic conditions, such as chronic allograft nephropathy. Single determinations of resistance indices present low diagnostic accuracy, which is higher in case of successive measurements performed during the follow-up of the graft. Modern techniques such as tissue pulsatility index, maximal fractional area and contrast-enhanced ultrasound increase ultrasonography diagnostic power in case of parenchymal complications of the transplanted kidney.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, "San Giovanni di Dio" Hospital, Agrigento, Italy ; Via F. Paradiso n°78/a, 95024 Acireale, CT Italy
| | - Pierpaolo Di Nicolò
- Nephrology and Dialysis Unit, "Santa Maria della Scaletta" Hospital, Imola, Bo Italy
| | - Viviana R Scarfia
- Nephrology and Dialysis Unit, "San Giovanni di Dio" Hospital, Agrigento, Italy
| | - Monica Insalaco
- Nephrology and Dialysis Unit, "San Giovanni di Dio" Hospital, Agrigento, Italy
| | - Paolo Lentini
- Nephrology and Dialysis Unit, "San Bassiano" Hospital, Bassano del Grappa, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Pasquale Fatuzzo
- Nephrology and Dialysis Unit, University Hospital of Catania, Catania, Italy
| | - Fulvio Fiorini
- Nephrology and Dialysis Unit, "Santa Maria della Consolazione" Hospital, Rovigo, Italy
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19
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Grzelak P, Kurnatowska I, Nowicki M, Strzelczyk J, Durczyński A, Podgórski M, Stefańczyk L. The diagnostic value of contrast-enhanced ultrasonography in the assessment of perirenal hematomas in the early post-operative period after kidney transplantation. Clin Transplant 2013; 27:E619-24. [PMID: 24118471 DOI: 10.1111/ctr.12257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Routine B-mode ultrasound examination (rB-US) is a current standard for the assessment of the transplanted kidney(KTx) in the early post-operative period. The alteration of perirenal hematoma (PH) echostructure over time limits their detectability and size assessment with rB-US. The aim of this study was to evaluate the diagnostic value of contrast-enhanced ultrasound (CE-US) in diagnosing PH of KTx in the early post-operative period. METHOD Routine B-US and CE-US of KTx, performed in 102 patients in the early post-operative period, were analyzed. CE-US was performed after intravenous administration of 2.4 mL of sulfur hexafluoride solution. The data were analyzed with respect to the occurrence and thickness of PH. RESULT The difference in echogenicity between PH and kidney parenchyma was modest in rB-US (mean of 5.7 dB). However, in CE-US, the difference in echogenicity was significantly increased (mean of 31.4 dB). Routine B-US did not allow PH to be recognized in 18 patients. The application of CE-US results in a twofold increase in PH detection when compared with rB-US (33.3% vs. 15.7%). CONCLUSION US-CE examination is a valuable method for detection and assessment of PH size. Compared with rB-US, this technique may substantially increase the detectability of hemorrhagic complications in the direct post-operative period.
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Affiliation(s)
- P Grzelak
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Lodz, Poland
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20
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Kolofousi C, Stefanidis K, Cokkinos DD, Karakitsos D, Antypa E, Piperopoulos P. Ultrasonographic features of kidney transplants and their complications: an imaging review. ISRN RADIOLOGY 2012; 2013:480862. [PMID: 24967275 PMCID: PMC4045518 DOI: 10.5402/2013/480862] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
Renal transplantation is the treatment of choice for managing patients with end-stage kidney disease. Being submitted to a very serious surgical procedure, renal transplant recipients can only benefit from follow-up imaging and monitoring strategies. Ultrasound is considered as the principal imaging test in the evaluation of renal transplants. It is an easily applied bedside examination that can detect possible complications and guide further imaging or intervention. In this imaging review, we present essential information regarding the sonographic features of healthy renal transplants, detailing the surgical technique and how it affects the sonoanatomy. We focus on various complications that occur following renal transplantation and their sonographic features by reviewing pertinent literature sources and our own extensive imaging archives.
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Affiliation(s)
| | | | | | | | - Eleni Antypa
- Radiology Department, Evangelismos Hospital, 10676 Athens, Greece
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21
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Onniboni M, De Filippo M, Averna R, Coco L, Zompatori M, Sverzellati N, Rossi C. Magnetic resonance imaging in the complications of kidney transplantation. Radiol Med 2012; 118:837-50. [PMID: 23090252 DOI: 10.1007/s11547-012-0891-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/28/2012] [Indexed: 11/28/2022]
Abstract
Kidney transplantation is currently the treatment of choice in most patients with end-stage chronic renal failure owing to the excellent results in terms of both graft and patient survival. However, surgical complications are still very frequent. Although urological (stricture, urinary fistulas, vesico-ureteral reflux) and lymphatic complications (lymphocoele) have a high incidence, they only rarely lead to graft loss. By contrast, vascular complications (stenosis, arterial and venous thrombosis, arterio-venous fistulas, pseudoaneurysms) are relatively rare, but potentially serious and may affect graft survival. Finally, medical complications such as acute tubular necrosis (ATN), rejection and de novo neoplasms may also arise in kidney transplantation. The purpose of this pictorial review is to illustrate the increasingly significant contribution of magnetic resonance angiography (MRA) in the management of complications of kidney transplantation, and emphasise how this method should now be considered a mandatory step in the diagnostic workup of selected cases. Moreover, the application and role in this setting of new magnetic resonance imaging (MRI) techniques, such as diffusion-weighted and blood oxygen level-dependent (BOLD) MRI, are also discussed.
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Affiliation(s)
- M Onniboni
- Scienze Radiologiche, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Padiglione Barbieri, 43100, Parma, Italy.
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22
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Grzelak P, Kurnatowska I, Nowicki M, Strzelczyk J, Sapieha M, Podgórski M, Marchwicka-Wasiak M, Stefańczyk L. Standard B presentation vs. contrast-enhanced ultrasound (US-CE). A comparison of usefulness of different ultrasonographic techniques in the evaluation of the echo structure and size of haematomas inpost-renal transplant patients: A preliminary report. Pol J Radiol 2012; 77:14-8. [PMID: 23049576 PMCID: PMC3447428 DOI: 10.12659/pjr.883369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/24/2012] [Indexed: 11/22/2022] Open
Abstract
Background: During routine ultrasonographic examination in B presentation, performed as a standard diagnostic procedure during the early post-operative period, the most important problem with the interpretation of the images of perirenal haematoma is their ability to change in time. The aim of this work was to assess the echogenicity and the size of perirenal haematomas in patients after kidney transplant during routine examinations in B presentation and during examinations enhanced with a contrast medium (CE-US). Material/Methods: Thirty-seven patients after kidney transplant were examined using standard examination in B presentation. Sixteen patients (7 women and 9 men) with isoechogenic and hypoechogenic areas visualized within the renal parenchyma, who were suspected of perirenal haematoma, underwent a CE-US examination after intravenous administration of sculpture hexafluoride (dose: 2.4 ml/examination). Using time-intensity curves (TIC), changes in the values were analysed for two areas of interest (ROI): in the renal parenchyma and in the areas identified during standard US as haematomas. Identical examination protocols and dynamic data loops allowed the acquisition of identical kidney cross-sections and enabled measuring the echogenicity and thickness of the abnormalities at the same location. Results: During the routine B presentation examination, the average difference between haematoma and the renal cortex was 5 dB. When performing US-CE examination, a significantly greater difference in echogenicity was observed and reached 31 dB. In six patients, the size of haematomas was comparable using both techniques, whereas in ten patients lesions visualized in B presentation were smaller than in the US-CE examination. Conclusions: The US-CE examination demonstrated a greater, statistically significant, difference in the echogenicity of perirenal haematomas compared to the routine examination in B presentation. This method enabled a more detailed assessment of the size of haematomas in the perirenal space that appeared during early post-operative period.
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Affiliation(s)
- Piotr Grzelak
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Łódź, Poland
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23
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Osband AJ, Laskow DA. Spermatocele following kidney transplant. Am J Transplant 2012; 12:1936-7. [PMID: 22487000 DOI: 10.1111/j.1600-6143.2012.04043.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lymphocele following kidney transplant is a common occurrence, but on occasion, what appears to be a lymphocele is not. We present an unusual case of a kidney transplant recipient whose presumed lymphocele was actually a spermatocele. Our patient is a 60-year-old man who is 11 years status post his second deceased donor kidney transplant. The original cause of his renal failure was poststreptococcal glomerulonephritis. He was followed with this nonobstructing lymphocele for years, but wished to have it addressed at the time of sigmoidectomy for recurrent diverticulitis. Preoperative imaging included CT scan, which showed a 12 cm × 6 cm collection, of greater density than simple fluid, adjacent to the bladder, and causing mass effect on the bladder. Intraoperatively, the collection was somewhat atypical for a lymphocele, and located posterior to the bladder. Cultures were negative, but evaluation of the fluid revealed it to be a spermatocele. Postoperative ultrasound demonstrated full resolution of the collection.
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Affiliation(s)
- A J Osband
- Robert Wood Johnson Medical School, NJ, USA.
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24
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Gill R, Shapiro R, Kayler LK. Management of peripheral vascular disease compromising renal allograft placement and function: review of the literature with an illustrative case. Clin Transplant 2010; 25:337-44. [DOI: 10.1111/j.1399-0012.2010.01351.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Irshad A, Ackerman SJ, Campbell AS, Anis M. An overview of renal transplantation: current practice and use of ultrasound. Semin Ultrasound CT MR 2009; 30:298-314. [PMID: 19711642 DOI: 10.1053/j.sult.2009.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Imaging has played a major role in monitoring the well-being of the renal graft. Ultrasound, in particular, has been extremely helpful for the detection of postoperative complications related to the transplant kidney. From an imaging perspective, the complications of renal transplantation can be categorized into vascular complications, complications related to the collecting systems (urological complications), perinephric fluid collections, and parenchymal complications. Additionally, there are some complications that may occur, secondary to a transplant renal biopsy. To be able to correctly identify the complications associated with renal transplants, one should have a comprehensive understanding of various aspects of the transplant procedure and be familiar with the normal or expected findings after a transplant. This article provides an overview of renal transplantation and discusses the use of various imaging modalities in its evaluation. The various complications associated with renal transplant as well as renal biopsy are elaborated in this article with special emphasis on the use of ultrasound.
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Affiliation(s)
- Abid Irshad
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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