renal transplant

Iliac fossa renal transplant connections

iliac vasculature, usually external

urinary bladder

Resistive index

PSV-EDV/PSV

renal transplant:

urologic complications

more common than vascular complications

obstruction

• normal to have mild hydro(denervation of ureter)

• obstruction point at ureteral implantation

Hematoma - post op

Urinoma - 2/52, rapid growth

• ureterovisicle anastomosis

Lymphocele - 1-2/12

• most common fluid collection to cause transplant hydronephrosis

Acute Tubular Necrosis

• delayed graft function(dialysis)

• cold ischemia

Cyclosporin toxicity ~1/12

• MAG3: normal perfusion, retained tracer

Renal Transplant:

Rejection

Hyperacute rejection

• rarely imaged, dead on arrival

Acute rejection - 1-3/52

• raised RI >0.8

• parenchymal oedema

Chronic rejection >3/12

• raised RI

• parenchymal edema

• thin cortex

• focal pyelonephritis

Renal Transplant:

Vascular complications

Renal Artery thrombosis - post op-1/12

Renal Artery Stenosis - 1 year

• most common vascular complication

• risk factor- CMV

• refractory hypertension

• PSV >200-300cm/s

• PSV ratio > 1.8-2.5

• Tardus parvus- main renal artery hilum

Renal Vein Thrombosis - 1/52

• reversed diastolic flow (artery)

Arteriovenous Fistula

• tissue vibration artefact aka color bruit artefact

Pseudoaneurysm

• yin-yang flow at the neck of pseudoaneurysm

Renal Allograft Compartment Syndrome

• < 2 hours, kidney is too big

• near absent cortical blood flow

Renal Transplant:

associated cancer

Non-melanomatous skin cancer

lymphoma

colon cancer

RCC in native kidney-papillary subtype

Post Transplant Lymphoproliferative Disorder(PTLD)

• EBV- Rituximab

Urothelial malignancy

• BK virus

• cyclophosphamide

MSK complication after renal transplant

femoral head AVN - steroid