Complications of Renal Transplantation

Akbar, Syed Ali; Jafri, Syed; Amendola, Marco A.; Madrazo, Beatrice L.; Salem, Riad; Bis, Kostaki G.

doi:10.1148/rg.255045133

Cited by 223 publications

(229 citation statements)

References 35 publications

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“…Postoperative minor complications following the renal transplant surgeries may lead to epididymitis, testicular swellings, testicular infarction, renal artery stenosis, renal artery thrombosis, etc., which are life threatening to the patients and therapeutically compromise such surgical procedures [14,15].…”

Section: Discussionmentioning

confidence: 99%

A Cadaveric Study about the Anomolous Origin of Testicular Arteries Arising from the Accessory Renal Arteries

et al. 2012

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Testicular arteries are paired vessels, arising from the abdominal aorta, at the level of second lumbar vertebra. Variations in the origin of these vessels highlight a potential importance regarding the vascular supply to the gonads and kidneys. This study was designed to assess the variations in the origin, course, and distance about the point of origin of the testicular arteries. The posterior abdominal walls of 40 male cadavers were studied on either side, during routine dissection in the Department of Anatomy, Kasturba Medical College, Manipal. A majority had a normal course and the variations were reported as: a) Bilateral origin of gonadal arteries from accessory renal arteries, b) Unilateral origin of the gonadal artery from the left accessory renal artery, and c) Unique origin of the right testicular artery from the right inferior epigastric artery and left testicular artery from descending thoracic aorta above the aortic opening of the diaphragm. Due to the embryological attribution, these variations in the testicular arteries indicate an alarming threat to the radiologists and surgeons during renal transplants and nephrectomies, as these vessels monopolize the vascular supply to the gonads. This study was undertaken to document the incidence of testicular arteries originating from accessory renal arteries.

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Section: Discussionmentioning

confidence: 99%

A Cadaveric Study about the Anomolous Origin of Testicular Arteries Arising from the Accessory Renal Arteries

et al. 2012

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“…Stricture of the distal ureter is more often due to scarring caused by ischemia or rejection. Less common causes of obstructive uropathy are pelvic fibrosis, compression due to perirenal fluid collections and kidney stones [4]. The latter is a rare complication in transplant kidneys and is reported in less than 2% of cases [5].…”

Section: Discussionmentioning

confidence: 99%

Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report

Lusenti

Fiorini²,

Barozzi

2009

Journal of Ultrasound

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Introduction: Obstructive uropathy caused by kidney stones is quite rare in transplant kidneys. Clinical case: The authors report the case of a patient, previously gastrectomized for gastric carcinoma. He underwent renal transplantation using uretero-ureterostomy, and presented an episode of acute renal failure 7 years after surgery. Ultrasound (US) examination showed no sign of rejection but allowed detection of moderate hydronephrosis in the transplant kidney. Subsequent computed tomography (CT) revealed a kidney stone in the middle ureter at the crossing of the iliac vessels. The patient therefore urgently underwent percutaneous nephrostomy of the graft and recovered diuresis and renal function. The patient was transferred to the Transplant Center where he underwent ureterotomy with removal of the stone and subsequent ureteropyelostomy. Also transureteral resection of the prostate (TURP) was performed due to urinary retention of prostatic origin. Histological examination showed prostate carcinoma, Gleason stage 3, which was treated conservatively using radiotherapy without suspension of the administered low dose of immunotherapy. Discussion: Calculosis is one of the least common causes of obstructive uropathy in transplant kidneys. In the described case, US examination performed after onset of renal insufficiency led to subsequent radiological investigation and resulting interventional procedures (nephrostomy and surgical removal of the stone) with complete recovery of pre-existing renal function.Sommario Introduzione: L'uropatia ostruttiva da calcolosi si verifica di rado nel rene trapiantato. Caso clinico: Gli autori riportano il caso di un paziente trapiantato renale mediante ureterostomia, già sottoposto a gastrectomia per carcinoma gastrico, che presenta episodio di insufficienza renale acuta 7 anni dopo l'intervento. L'esame ecografico non mostra segni di rigetto e permette di evidenziare viceversa un'idronefrosi di grado non marcato a carico del rene trapiantato. La successiva TC rivela calcolo del tratto medio dell'uretere a livello dell'incrocio con i vasi iliaci. Il paziente viene pertanto sottoposto, in urgenza, a nefrostomia percutanea del graft con buona ripresa della diuresi e della funzionalità renale. Inviato presso il Centro * Corresponding author. Sezione di Nefrologia Preventiva, Dipartimento di Nefrologia e Dialisi, Ospedale di S.ta Maria Nuova, Via Gadda 30, 42100 Reggio Emilia, Italy.E-mail address: lusenti.tiziano@asmn.re.it (T. Lusenti). Trapianti di competenza viene sottoposto ad intervento di ureterotomia con asportazione del calcolo e successiva uretero-pielotomia. Per ritenzione urinaria di origine prostatica viene inoltre sottoposto a TURP. L'esame istologico mostra carcinoma prostatico stadio 3 sec. Gleason, che si decide di trattare in modo conservativo con radioterapia, con mantenimento della già blanda terapia immunodepressiva. Discussione: La calcolosi viene annoverata tra le cause meno comuni di uropatia ostruttiva del rene trapiantato. Nel caso descritto l'ecografi...

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“…The role of this technique is limited by the rapid organ destruction related to the thrombotic and inflammatory processes which involve the graft. The prognosis is scarce with a graft loss rate over 60 % [8,9]. The echographic characteristics are extremely nonspecific and similar to those observed in case of acute rejection and acute tubular necrosis.…”

Section: Hyperacute and Accelerated Rejectionmentioning

confidence: 92%

“…Immediate parenchymal complications are often responsible for a delay in the recovery of the graft function and are related to a higher rate of hospitalisation and a worse graft survival both in the short and in the long period [8]. These complications are essentially represented by hyperacute and accelerated rejection, acute tubular necrosis (ATN), calcineurin inhibitors' toxicity and pyelonephritis.…”

Section: Doppler Ultrasound and The Timing Of The Complicationsmentioning

confidence: 99%

Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do

et al. 2014

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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.Keywords Ultrasonography Á Doppler ultrasound Á Renal transplantation Á Parenchymal complications Sommario Il trapianto di rene è il trattamento di scelta nella malattia renale allo stadio terminale, data la migliore qualità di vita dei pazienti trapiantati rispetto a quelli che continuano il trattamento dialitico. Nonostante i miglioramenti chirurgici e nuovi regimi immunosoppressivi, parte dei pazienti trapiantati sviluppano ancora disfunzioni croniche. L'ecografia, sia in B-mode che Doppler, è un importante strumento diagnostico in caso di condizioni cliniche che possono alterare la funzione renale. Anche se l'ecografia è considerata fondamentale nella diagnosi di complicanze chirurgiche e vascolari del rene trapiantato, il suo ruolo non è pienamente conosciuto in caso di (2015) 18:109-116 DOI 10.1007/s40477-014-0118-1 complicanze parenchimali. La specificità del Doppler è bassa, sia in caso complicanze acute, quali la necrosi tubulare acuta, la tossicità acuta da farmaci, il rigetto, sia in caso di complicanze croniche, come la nefropatia cronica del trapianto. Singole determinazioni di indici di resistenza presentano bassa accuratezza diagnostica, che è più elevata in caso di misure effettuate successivamente durante il follow-up del trapianto. Tecniche moderne, come l'indice di pulsatilità tissutale, massima frazione di zona ed ecografia con mdc aumentano le potenzialità diagnostiche dell'ecografia in caso di complicanze parenchimali del rene trapiantato.

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Complications of Renal Transplantation

Cited by 223 publications

References 35 publications

A Cadaveric Study about the Anomolous Origin of Testicular Arteries Arising from the Accessory Renal Arteries

A Cadaveric Study about the Anomolous Origin of Testicular Arteries Arising from the Accessory Renal Arteries

Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report

Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do

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