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RENAL TRANSPLANT

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Surgical implantation into right or left iliac fossa, most often on the right. ... fossa to facilitate the vascular anastomosis and ensure correct orientation ... – PowerPoint PPT presentation

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Title: RENAL TRANSPLANT


1
RENAL TRANSPLANT
2
History
  • First successful transplant 1954
  • 2 year survival rate is gt90 at present

3
Eligible Patients
  • Patient must have evidence of endstage renal
    failure, defined as current or impending dialysis
    dependency.
  • Indications
  • Glomerulonephritis (55)
  • Diabetic nephropathy (20-30)
  • Chronic pyelonephritis (8)
  • Polycystic kidney disease (5)

4
Contraindications
  • Systemic malignancy
  • Active infection
  • Seropositivity, i.e., HIV, Hepatitis B
  • Noncompliant patient

5
Renal Allograft
  • Allograft Any tissue transplanted from one
    human to another.
  • Renal allograft harvested
  • From living, related donor
  • From brain dead donor (cadaveric)

6
Surgical Technique
  • Surgical implantation into right or left iliac
    fossa, most often on the right.
  • Generally, donor kidney is flipped
    anteroposteriorly before being placed in the
    iliac fossa to facilitate the vascular
    anastomosis and ensure correct orientation of the
    ureter.

7
Vascular Hookup
  • Due to its lower incidence of renal artery
    stenosis, an end renal artery to side
    external iliac artery anastomosis is preferred
    over end renal artery to end internal iliac
    artery.
  • End to side anastomosis between the renal
    vein and the external iliac vein.

8
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9
A end-to-side anastomosis, allograft artery to
external iliac artery B end-to-end
anastomosis, allograft artery to internal iliac
artery C Carrells patch from the donor
aorta. Utilized for multiple renal arteries or
for a small renal artery from a child.
10
Technical Considerations
  • Superficial
  • Anatomic detail is clearer
  • Cortex may appear more echogenic
  • Enlarges
  • Adults, volume typically increases up to 30
  • May increase up to 200 with discrepancy of donor
    to recipient size
  • Dilatation of collecting system
  • Slight hydronephrosis is common

11
Rejection
  • Sonographic Manifestations
  • Increased allograft size
  • Increased cortical echogenicity
  • Increased prominence of renal pyramids
  • Focal cortical hypoechoic regions
  • Decreased echogenicity of renal sinus
  • Increased flow resistance in parenchymal arteries

12
Rejection
Acute
Chronic
13
Increased Flow Resistance
  • Zwiebel, Pg. 469
  • RI 0.7
  • Renal Transplant Imaging and Intervention
  • RI gt0.9

14
Perigraft Fluid Collections
  • Seroma Hematoma
  • Abscess
  • Urinoma
  • Lymphocele
  • Zwiebel, pg. 471 Table 30-3

15
Lymphocele
16
Vascular Complications
  • Arterial Stenosis
  • Most common vascular complication, 10 of
    transplant patients
  • Early most often a technical defect
  • Later generally due to intimal hyperplasia
  • Vascular Occlusion typically immediate, lt1 week
  • Renal artery
  • lt1 of all renal transplants
  • Typically appears acutely
  • Technical defect
  • Rejection
  • Renal vein
  • lt1 of transplant patients

17
Diagnostic Criteria
  • Normal Flow Parameters
  • Velocity 80 118 cm/s
  • Volume flow 346 422 cc/minute
  • Abnormal Flow Parameters stenosis gt5060
  • Velocity gt190 cm/s with poststenotic turbulence
  • Velocity 250 cm/s
  • Systolic velocity ratio gt3

18
Renal Artery Stenosis
19
Renal Artery Stenosis
20
Renal Vein ThrombosisDoppler Flow Characteristic
21
Vascular Complications
  • Arteriovenous Fistula
  • Generally due to trauma from renal biopsy
  • Pseudoaneurysm
  • Generally due to trauma from renal biopsy
  • May be at arterial or venous anastomosis

22
A-V Fistula
23
Pseudoaneurysm
24
Pseudoaneurysm
25
Sources
  • Introduction to Vascular Ultrasonography, 4th
    Ed., Zwiebel, Chapter 30
  • Renal Transplant Imaging and Intervention,
    Zwirewich
  • www.radiology.co.uk/srs - x/tutors/renaltx/re
    n1.htm
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