ACR Appropriateness Criteria ® Renal Transplant Dysfunction

Abstract

Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions. Nuclear medicine studies, CT, and MRI are often helpful as complementary examinations for specific indications. Angiography remains the reference standard for vascular complications and is utilized to guide nonsurgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Amiloidosis Asociada a Hemodiálisis: Revisión Literaria

“…El trasplante renal es la opción terapéutica preferida en pacientes con ERC terminal que presentan AAH, debido a que mejora los síntomas rápidamente [10,45]. Este procedimiento se puede realizar por medio de dos técnicas: la laparoscopia y la cirugía abierta.…”

“…El manejo inicial es sintomático, dependiendo de la articulación que se encuentre afectada; no obstante, el tratamiento de elección en estos pacientes es el trasplante renal. La restauración de la función renal a través de este método hace que los depósitos de β2M se reduzcan, deteniendo así el progreso de la enfermedad y mejorando signi cativamente los síntomas asociados a ella [10][11][12].…”

Role for contrast-enhanced ultrasound in assessing complications after kidney transplant

“…The cut-off for pathologic TRA velocity varies between 200 and 300 cm/sec according to different Authors. The lower limit suffers from low specificity, and in turn can cause an excessive number of unnecessary procedures[ 3 ]. Controversy exists also with regard to the best RI cut-off[ 22 ].…”

“…Ultrasound (US) with color Doppler analysis has become the preferred imaging tool to evaluate the graft status within the first 24 h after KT[ 3 ]. Together with serial biopsies of the allograft parenchyma, this technique plays also a pivotal role in post-KT surveillance, aiming to diagnose post-surgical complications, acute rejection, or chronic allograft nephropathy[ 3 , 4 ]. On the other hand, color Doppler US is characterized by a low specificity, with Doppler-derived measures, such as the resistance index (RI), not directly reflecting the status of microcirculation[ 5 ].…”

“…On the other hand, color Doppler US is characterized by a low specificity, with Doppler-derived measures, such as the resistance index (RI), not directly reflecting the status of microcirculation[ 5 ]. Computed tomography (CT) and magnetic resonance imaging (MRI) represent second-line imaging modalities used for assessing inconclusive US findings, providing a panoramic representation of vascular complications, and characterizing perirenal collections or renal masses[ 3 ]. However, those modalities are rarely used because of the need to administer contrast medium, which is nephrotoxic in the case of CT, and at risk of raising gadolinium-related safety issues when MRI is planned in patients with impaired renal function.…”