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Yang WQ, Cui XL, Zhang M, Yuan XD, Ying L, Li FH, Li HL. Preoperative evaluation of iliac blood vessels for first kidney transplant recipients: Combination of conventional and contrast-enhanced ultrasonography. Clin Hemorheol Microcirc 2021; 78:139-149. [PMID: 33554892 DOI: 10.3233/ch-201054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess iliac blood vessels using conventional ultrasound (US) and contrast-enhanced ultrasonography (CEUS) before kidney transplantation (KT) and determine whether US findings related to post-transplant outcomes. METHODS A total of 119 patients received US and CEUS before KT waiting-list acceptance. The preoperative iliac blood hemodynamics and vascular conditions were evaluated. The operative strategy and follow-up outcomes were recorded. Logistic regression and correlation analysis were used. The accuracy in determining the patency of iliac blood vessels was calculated before and after the injection of contrast materials. RESULTS CEUS can help to significantly improve the visualization of the internal iliac artery, but there was no significant correlation with post-transplant outcomes. In terms of accuracy, there were significant differences in determining the patency of internal iliac arteries between conventional US and CEUS (60.5% and 100%, p < 0.001). The surgical strategy of one patient was regulated and two patients were excluded from KT according to US findings. CONCLUSIONS Compared with conventional US, CEUS helps to improve the visualization of the internal iliac artery. Conventional US and CEUS have the potential to serve as effective methods to evaluate anatomy and hemodynamics of iliac vessels and have a potential value while defining clinical algorithms in surgery decision-making.
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Affiliation(s)
- Wen-Qi Yang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao-Lan Cui
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ming Zhang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao-Dong Yuan
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Liang Ying
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Feng-Hua Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hong-Li Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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2
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Dammann E, Groth M, Schild RS, Lemke A, Oh J, Adam G, Herrmann J. B-Flow Sonography vs. Color Doppler Sonography for the Assessment of Vascularity in Pediatric Kidney Transplantation. ROFO-FORTSCHR RONTG 2020; 193:49-60. [PMID: 32516824 DOI: 10.1055/a-1167-8317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare B-flow sonography (BFS) with color Doppler sonography (CDS) for imaging of kidney transplant vascularization in children. PATIENTS AND METHODS All children receiving a kidney transplantation who underwent a protocol-based ultrasound examination (Loqiq 9, GE Medical Systems, Milwaukee, WI, USA) using the BFS and CDS technique with equal settings and probe position between January 2013 and January 2016 were retrospectively assessed (n = 40). The obtained datasets were visually graded according to the following criteria: (I) delineation of the renal vascular tree (Grade 1 - clear demarcation of interlobar, together with arcuate and interlobular vessels; Grade 2 - clear demarcation of interlobar and cortical vessels, but no distinction of interlobular from arcuate vessels; Grade 3 - only clear demarcation of interlobar vessels, Grade 4 - insufficient demarcation) (II) delineation of cortical vessel density in ventral, lateral, and dorsal part of the transplant, (III) smallest vessel-capsule distance, and (IV) maximum cortical vessel count. Comparison between methods was performed using Fisher's exact and paired sample t-tests. RESULTS Applying a curved transducer (C1-6), BFS showed superior delineation of the renal vascular tree (p < 0.001), a lower vessel-capsule distance (p < 0.001), a higher cortical vessel count (p < 0.001), and a higher cortical vessel density in the superficial cortex (p = 0.01) than CDS. In the dorsal and lateral aspects of the transplant, cortical vessel density was lower with BFS (both p < 0.001). Using a linear high-resolution transducer (ML 6-15), no significant differences between the methods were found. CONCLUSION Improved imaging of kidney transplant vascularization can be achieved in children by adding BFS to a standard protocol. The BFS technique is especially beneficial for overall assessment of the renal vascular tree together with the extent of cortical vascularization on curved array images. KEY POINTS · Depiction of vascular tree and ventral cortical vessels is improved by BFS.. · The dorso-lateral cortex was better represented with CDS because of higher penetration.. · Additional monitoring with BFS improves the monitoring of transplant viability.. CITATION FORMAT · Dammann E, Groth M, Schild R et al. B-Flow Sonography vs. Color Doppler Sonography for the Assessment of Vascularity in Pediatric Kidney Transplantation. Fortschr Röntgenstr 2021; 193: 49 - 60.
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Affiliation(s)
- Elena Dammann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Groth
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael-Sebastian Schild
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Lemke
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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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: 2] [Impact Index Per Article: 0.3] [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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Optimizing Efficiency in the Evaluation of Living Donor Candidates: Best Practices and Implications. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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La transplantation rénale et ses défis. Prog Urol 2016; 26:1001-1044. [PMID: 27720627 DOI: 10.1016/j.purol.2016.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 01/09/2023]
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6
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Hanssen O, Erpicum P, Lovinfosse P, Meunier P, Weekers L, Tshibanda L, Krzesinski JM, Hustinx R, Jouret F. Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I. In vivo imaging methods. Clin Kidney J 2016. [PMID: 28643821 PMCID: PMC5469561 DOI: 10.1093/ckj/sfw062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ultimately relies on transplant needle biopsy. However, such an invasive procedure is associated with a significant risk of complications and is limited by sampling error and interobserver variability. In the present review, we summarize the current literature about non-invasive approaches for the diagnosis of AR in kidney transplant recipients (KTRs), including in vivo imaging, gene expression profiling and omics analyses of blood and urine samples. Most imaging techniques, like contrast-enhanced ultrasound and magnetic resonance, exploit the fact that blood flow is significantly lowered in case of AR-induced inflammation. In addition, AR-associated recruitment of activated leukocytes may be detectable by 18F-fluoro-deoxy-glucose positron emission tomography. In parallel, urine biomarkers, including CXCL9/CXCL10 or a three-gene signature of CD3ε, IP-10 and 18S RNA levels, have been identified. None of these approaches has been adopted yet in the clinical follow-up of KTRs, but standardization of procedures may help assess reproducibility and compare diagnostic yields in large prospective multicentric trials.
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Affiliation(s)
- Oriane Hanssen
- Division of Nephrology, University of Liège Academic Hospital (ULg CHU), Avenue Hippocrate, 13, B-4000 Liège, Belgium
| | - Pauline Erpicum
- Division of Nephrology, University of Liège Academic Hospital (ULg CHU), Avenue Hippocrate, 13, B-4000 Liège, Belgium.,GIGA Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Pierre Lovinfosse
- Division of Nuclear Medicine, University of Liège Academic Hospital (ULg CHU), Liège, Belgium
| | - Paul Meunier
- Division of Radiology, University of Liège Academic Hospital (ULg CHU), Liège, Belgium
| | - Laurent Weekers
- Division of Nephrology, University of Liège Academic Hospital (ULg CHU), Avenue Hippocrate, 13, B-4000 Liège, Belgium
| | - Luaba Tshibanda
- Division of Radiology, University of Liège Academic Hospital (ULg CHU), Liège, Belgium
| | - Jean-Marie Krzesinski
- Division of Nephrology, University of Liège Academic Hospital (ULg CHU), Avenue Hippocrate, 13, B-4000 Liège, Belgium.,GIGA Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine, University of Liège Academic Hospital (ULg CHU), Liège, Belgium
| | - François Jouret
- Division of Nephrology, University of Liège Academic Hospital (ULg CHU), Avenue Hippocrate, 13, B-4000 Liège, Belgium.,GIGA Cardiovascular Sciences, University of Liège, Liège, Belgium
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7
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Blankholm AD, Pedersen BG, Stausbøl-Grøn B, Andersen G, Hørlyck A, Østrat EØ, Laustsen S, Ringgaard S. Preoperative planning of renal transplantation: a comparison of non-contrast-enhanced ultrasonography, computed tomography, and magnetic resonance angiography with observations from surgery. Acta Radiol 2015; 56:1527-33. [PMID: 25512947 DOI: 10.1177/0284185114562227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/07/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many candidates for kidney transplantation need to undergo vessel examination before the transplantation procedure. PURPOSE To identify the optimal preoperative modality for the examination of vessel status without the use of contrast agents in kidney transplant candidates. MATERIAL AND METHODS Fifty-three consecutive patients were examined and 31 patients were transplanted. Ultrasonography (US), non-contrast-enhanced computed tomography (NCCT), and non-contrast-enhanced magnetic resonance angiography (NCMRA) were compared using inspection during kidney transplantation (TX) as a reference standard. The sensitivity and specificity to severe arteriosclerotic changes and the accuracy were calculated. Kappa statistics were used to assess the agreement between TX and the different examination modalities, and McNemar's test was used to test for significant differences. RESULTS US had higher sensitivity (1.0) and better agreement with observations from surgery (k = 0.89) than both NCCT (sensitivity = 0.60; k = 0.72) and NCMRA (sensitivity = 0.20; k = 0.30). No significant difference was found between TX and US (P = 0.3173) or TX and NCCT (P = 0.1573), but there was a significant difference between TX and NCMRA (P = 0.0455). US was inconclusive in 20% of cases, and the internal iliac artery could not be visualized in 69% of cases. CONCLUSION Either US or NCCT can be used as the preferred preoperative imaging modality to examine vessel status before kidney transplantation, but a combination of the two is preferable. NCMRA should not be used as the sole imaging modality for preoperative imaging before kidney transplantation because of its low sensitivity in detecting severe arteriosclerotic disease without the presence of stenosis.
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Affiliation(s)
- Anne Dorte Blankholm
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bodil G Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ernst Ø Østrat
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Sussie Laustsen
- Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Steffen Ringgaard
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- MR Research Centre, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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8
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Patil S, Sun H, Geffner S, Stephen Fletcher H, Chamberlain RS. Renal Transplantation in Patients with Aortoiliac Prosthetic Grafts: A Case Report and Pertinent Review of Literature. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojots.2015.51001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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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: 0.8] [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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10
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Bou Matar R, Warshaw B, Hymes L, Greenbaum LA. Routine transplant Doppler ultrasonography following pediatric kidney transplant. Pediatr Transplant 2012; 16:607-12. [PMID: 22554083 DOI: 10.1111/j.1399-3046.2012.01712.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The utility and cost-effectiveness of routine transplant renal DU as a screening test in the immediate postoperative period following pediatric renal transplantation has not been systematically evaluated. Our center's transplant protocol includes a routine DU on postoperative day 3, unless an earlier DU was obtained for a specific indication. We retrospectively evaluated 113 consecutive pediatric renal transplant recipients. Indication for DU (routine vs. non-routine), timing, results, and graft outcome data were collected. We determined whether the DU result affected patient management. Eighty routine DU examinations were evaluated. Thirty (37.5%) of the 80 routine DUs had abnormalities. Most abnormalities were minor and did not require intervention. One patient with a dysfunctional bladder had mild hydronephrosis; this led to a decision to increase the frequency of bladder catheterization. This was the only intervention based upon the routine DUs. Twenty percent of routine DUs revealed abnormalities that led to a follow-up study, but none of these studies led to an intervention. The incremental cost of each DU exceeded $1080 and the incremental cost-effectiveness ratio for a documented change in management exceeded $86, 400. Our results suggest that routine post-transplant DU is not cost-effective in pediatric renal allograft recipients.
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11
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Immediate renal Doppler ultrasonography findings (<24 h) and its association with graft survival. World J Urol 2011; 29:547-53. [DOI: 10.1007/s00345-011-0666-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/21/2011] [Indexed: 10/18/2022] Open
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12
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Subesinghe M, Cherukuri A, Ecuyer C, Baker RJ. Who should have pelvic vessel imaging prior to renal transplantation? Clin Transplant 2011; 25:97-103. [DOI: 10.1111/j.1399-0012.2010.01218.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Aalten J, Dekker HM, van der Vliet JA, Hoitsma AJ. Does a plain X-ray of the pelvis predict arterial complications in renal transplantation? A prospective study. Nephrol Dial Transplant 2010; 26:2007-12. [DOI: 10.1093/ndt/gfq705] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Son H, Heiba S, Kostakoglu L, Machac J. Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of accompanying SPECT/CT - a case report. BMC Med Imaging 2010; 10:23. [PMID: 20961409 PMCID: PMC2984463 DOI: 10.1186/1471-2342-10-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 10/20/2010] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The differentiation of the nature of a fluid collection as a complication of kidney transplantation is important for management and treatment planning. Early and delayed radionuclide renography can play an important role in the evaluation of a urine leak. However, it is sometimes limited in the evaluation of the exact location and extent of a urine leak. CASE PRESENTATION A 71-year-old male who had sudden anuria, scrotal swelling and elevated creatinine level after cadaveric renal transplantation performed Tc-99 m MAG3 renography to evaluate the renal function, followed by an ultrasound which was unremarkable. An extensive urine leak was evident on the planar images. However, an exact location of the urine leak was unknown. Accompanying SPECT/CT images confirmed a urine leak extending from the lower aspect of the transplant kidney to the floor of the pelvic cavity, presacral region and the scrotum via right inguinal canal as well as to the right abdominal wall. CONCLUSIONS Renal scintigraphy is very useful to detect a urine leak after renal transplantation. However, planar imaging is sometimes limited in evaluating the anatomical location and extent of a urine leak accurately. In that case accompanying SPECT/CT images are very helpful and valuable to evaluate the anatomical relationships exactly.
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Affiliation(s)
- Hongju Son
- The Division of Nuclear Medicine, Department of Radiology, The Mount Sinai School of Medicine, New York, NY, USA.
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15
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Bia M, Adey DB, Bloom RD, Chan L, Kulkarni S, Tomlanovich S. KDOQI US commentary on the 2009 KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Kidney Dis 2010; 56:189-218. [PMID: 20598411 DOI: 10.1053/j.ajkd.2010.04.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 04/26/2010] [Indexed: 12/14/2022]
Abstract
In response to recently published KDIGO (Kidney Disease: Improving Global Outcomes) guidelines for the care of kidney transplant recipients (KTRs), the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) organized a working group of transplant nephrologists and surgeons to review these guidelines and comment on their relevance and applicability for US KTRs. The following commentaries on the KDIGO guidelines represent the consensus of our work group. The KDIGO transplant guidelines concentrated on aspects of transplant care most important to this population in the posttransplant period, such as immunosuppression, infection, malignancy, and cardiovascular care. Our KDOQI work group concurred with many of the KDIGO recommendations except in some important areas related to immunosuppression, in which decisions in the United States are largely made by transplant centers and are dependent in part on the specific patient population served. Most, but not all, KDIGO guidelines are relevant to US patients. However, implementation of many may remain a major challenge because of issues of limitation in resources needed to assist in the tasks of educating, counseling, and implementing and maintaining lifestyle changes. Although very few of the guidelines are based on evidence that is strong enough to justify their being used as the basis of policy or performance measures, they offer an excellent road map to navigate the complex care of KTRs.
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Affiliation(s)
- Margaret Bia
- Yale School of Medicine, New Haven, CT 06520-8029, USA
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16
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Abstract
The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.
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17
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Ploussard G, Mongiat-Artus P, Meria P, Tariel E, Gaudez F, De Kerviler E, Legendre C, Peraldi MN, Glotz D, Desgrandchamps F. What is the relevance of systematic aorto-femoral Doppler ultrasound in the preoperative assessment of patients awaiting first kidney transplantation: a monocentric prospective study. Nephrol Dial Transplant 2009; 25:270-4. [PMID: 19749144 DOI: 10.1093/ndt/gfp459] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The purpose of our study was to study the relevance of a systematic aorto-femoral colour Doppler ultrasound (DUS) in the evaluation of first renal transplant receivers. METHODS We prospectively studied 100 consecutive first renal transplant (RT) receivers. All patients had a preoperative physical examination with a careful vascular system evaluation including assessment of risk factors and colour DUS of aortic, iliac and femoral arteries. Renal transplantation was planned in the right iliac fossa with end-to-lateral vascular anastomoses. Clinical parameters, DUS results, operative and post-operative parameters at 3 months were compared according to the vascular assessment. RESULTS Among the 84 patients presenting with a normal preoperative physical arterial examination, 12 patients (14.3%) had an abnormal DUS, revealing atherosclerotic arteries, but no case of arterial stenosis. Among the 16 patients with abnormal physical arterial examination, 10 patients (62.5%) had abnormal DUS, including 4 cases of iliac stenosis. In 3 of the 16 patients (18.8%), DUS revealed right iliac artery stenosis requiring a modification in the surgical procedure. No additional vascular procedure was reported in the case of normal preoperative vascular examination. No technical problems during arterial anastomosis and no post-transplantation arterial complications were reported. In multivariate analysis, abnormal physical examination was the most significant risk factor of atherosclerotic infiltration in DUS. CONCLUSION The abnormality of arterial physical examination is the best clinical predictor of abnormal DUS in preoperative assessment of renal transplant receivers. However, the low sensitivity and positive predictive value of the physical examination do not support the conclusion that DUS can be avoided in patients with normal arterial physical examination. Nevertheless, in the case of arterial physical abnormality, 'for case' DUS is critical and helps in the surgical strategy in approximately 20% of cases.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology and Paris 7 University, Saint Louis Hospital, Paris, France
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Dede F, Ones T, Caliskan B, Civen H, Erdil TY, Inanir S, Tuglular ZS, Yegen C, Akoglu E, Turoglu HT. Simple provocative maneuvers in renal transplant scintigraphy for detecting urine leak. Ann Nucl Med 2007; 21:603-6. [PMID: 18092138 DOI: 10.1007/s12149-007-0065-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 09/04/2007] [Indexed: 11/28/2022]
Abstract
Urine leak in the early postoperative period following renal transplantation is a serious complication requiring early identification and aggressive intervention, which significantly reduces the morbidity and mortality. Renal transplant scintigraphy is a noninvasive method to evaluate the perfusion and function of a transplanted kidney and urinary drainage including urine leak. Here, we reported two cases in which the standard transplant renogram failed to demonstrate urine leak. The cases were referred for a diethylenetriaminepentaacetic acid renogram following the transplantation to evaluate the cause of symptoms or elevated serum creatinine level. In both the cases, urine leak was successfully detected following simple maneuvers such as diuretic administration or Foley catheter irrigation. Renal transplant scintigraphy is an effective and safe technique and the use of these simple maneuvers can enhance the diagnostic sensitivity of the transplant renogram in the detection of urine leak.
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Affiliation(s)
- Fuat Dede
- Bulgurlu Mahallesi Hanimseti Cikmazi Sokak, No. 2, A Blok, Daire 2, Uskudar, Istanbul 34696, Turkey.
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19
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Modi P. Pertinent issues in pretransplant recipient workup. Indian J Urol 2007; 23:278-85. [PMID: 19718331 PMCID: PMC2721607 DOI: 10.4103/0970-1591.33725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Renal transplantation is recognized as the treatment of choice in most patients with end-stage renal disease. The evaluation of the candidate for kidney transplantation has been the recent subject of clinical practice guidelines published by the European Renal Association- European Dialysis Transplant Association and the American Society of Transplantation. The purpose of this article is to review the current literature for urological evaluation and treatment of patients prior to renal transplantation. In India, urologists are involved in evaluating not only the genitourinary problems but also vascular access and, vascular anatomy and pathology especially related to major pelvic vessels. Hence, evaluation of the transplant recipient should include assessment of vascular access for hemodialysis, access for peritoneal dialysis, assessment of pelvic vessels to which renal allograft vessels need to be anastomosed and genitourinary system. In addition, review of the serological tests for infective viral diseases like hepatitis and human immunodeficiency viruses should always be done before starting clinical evaluation. A note of the evaluation performed by other specialists like nephrologist, cardiologist, endocrinologist, pulmonologist, anesthetist etc. should always be reviewed.
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Affiliation(s)
- Pranjal Modi
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad - 380 016, India
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20
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Rau MM, Setty BN, Blake MA, Ouellette-Piazzo K, Hahn PF, Sahani DV. Evaluation of Renal Transplant Donors with 16-Section Multidetector CT Angiography: Comparison of Contrast Media with Low and High Iodine Concentrations. J Vasc Interv Radiol 2007; 18:603-9. [PMID: 17494841 DOI: 10.1016/j.jvir.2007.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare the degree of contrast enhancement, image quality, and accuracy of renal computed tomographic (CT) angiography performed with a 16-detector row CT unit and equal iodine doses of low- and high-iodine-concentration contrast medium in the evaluation of renal transplant donors. MATERIALS AND METHODS Eighty donors scheduled to undergo renal CT angiography with 16-detector row CT were administered nonionic contrast media with two iodine concentrations. The first group (group A, n=40) received a contrast medium with 300 mg of iodine per milliliter, and the second group (group B, n=40) received a contrast medium with 370 mg of iodine per milliliter. An equal iodine dose of 550 mg per kilogram body weight was given to both groups. Contrast enhancement was quantified by measuring attenuation in the abdominal aorta and in both renal arteries. Subjective assessment of contrast enhancement, quality of reformatted images, and visualization of branch order of renal arteries were rated with a 5-point scale. The number of renal arteries and veins seen at CT was correlated with the results at surgery. RESULTS The mean enhancement values in group B were significantly greater (P<.001) than those in group A. The mean HU (+/-standard deviation) in groups A and B were 298+/-76 and 344+/-75, respectively, in the aorta, 284+/-74 and 331+/-71 in the right renal artery, and 285+/-72 and 329+/-73 in the left renal artery. The mean enhancement, image quality, and branch orders visualized were rated better in group B than in group A (P<.01). The accuracies for correctly identifying renal arteries and veins, respectively, were 91% and 95% for group A and 96% and 96% for group B. CONCLUSION Renal donor CT angiography with a contrast medium of 370 mg of iodine per milliliter provides greater enhancement and image quality compared with a contrast medium of 300 mg of iodine per milliliter. The diagnostic accuracies were similar.
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Affiliation(s)
- Matthew M Rau
- Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, White 270, 55 Fruit St, Boston, MA 02114, USA
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21
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Schlunt LB, Harper JD, Broome DR, Baron PW, Watkins GE, Ojogho ON, Baldwin DD. Improved Detection of Renal Vascular Anatomy Using Multidetector CT Angiography: Is 100% Detection Possible? J Endourol 2007; 21:12-7. [PMID: 17263601 DOI: 10.1089/end.2006.0257] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Multidetector CT angiography (MDCTA) is being used increasingly to evaluate vascular anatomy prior to donor nephrectomy. To improve the ability of MDCTA to predict donor renal anatomy, a novel protocol including four-phase imaging with three-dimensional reconstruction and maximum intensity projections (MIPs) was incorporated into the standard donor evaluation. The purpose of this study was to determine the results of this protocol. PATIENTS AND METHODS Seventy consecutive patients who underwent hand-assisted laparoscopic donor nephrectomy between January 2003 and September 2004 were reviewed. All MDCTA studies were examined initially by a radiologist alone, after which, a second preoperative reading was performed by a radiologist and the operating surgeon together. The two reviews were compared with the operative findings. RESULTS Using this protocol to detect the total number of renal arteries, veins, and ureters, the sensitivity of the initial radiologist was 97%, 100%, and 96%, respectively. These values increased to 100%, 100%, and 99% when the films were reviewed by a radiologist together with the surgeon who would operate on the donor. The sensitivity, specificity, and accuracy in predicting supernumerary arteries, including early (< or =1-cm) arterial branching was 89%, 100%, and 97%, respectively after the single reading but increased to 100%, 100%, and 100% with the combined reading. CONCLUSIONS An MDCTA study with this protocol provides excellent anatomic detail prior to donor nephrectomy. Its ability to predict renal-arterial and ureteral anatomy is enhanced when the films are reviewed simultaneously by a radiologist and the operating surgeon.
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Affiliation(s)
- Lori B Schlunt
- Division of Urology, Loma Linda University Medical Center, Loma Linda, California 92354, USA
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22
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Rastogi N, Sahani DV, Blake MA, Ko DC, Mueller PR. Evaluation of Living Renal Donors: Accuracy of Three-dimensional 16-Section CT. Radiology 2006; 240:136-44. [PMID: 16720871 DOI: 10.1148/radiol.2401050780] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively assess the sensitivity and specificity of three-dimensional (3D) 16-section computed tomography (CT) in the evaluation of vessels, pelvicalyceal system, and ureters in living renal donors, with surgical findings as the reference standard. MATERIALS AND METHODS This was a HIPAA-compliant study. Institutional review board approval was obtained for the review of subjects' medical records and data analysis, with waiver of informed consent. Forty-six renal donors (18 men, 28 women; mean age, 42 years) were examined with 16-section CT. Two blinded reviewers independently studied renal vascular and urographic anatomy of each donor CT scans by fist using 3D images alone, then transverse images alone, and finally transverse and 3D data set. Image quality, degree of diagnostic confidence, and time used for review were recorded. Sensitivity and specificity were calculated. RESULTS For 3D images, transverse images, and transverse in conjunction with 3D data sets, the respective sensitivity and specificity of CT in evaluation of accessory arteries by reviewer 1 were 100% and 100%, 89% and 100%, and 100% and 100%, and those by reviewer 2 were 89% and 97%, 89% and 100%, and 89% and 100%; the respective sensitivity and specificity in evaluation of venous anomalies by reviewer 1 were 100% and 98%, 100% and 98%, and 100% and 98%, and those by reviewer 2 were 100% and 98%, 100% and 95%, and 100% and 98%. For focused comprehensive assessment of renal donors with 3D scans alone, a reviewer on average (average of reviewers 1 and 2) used 2.4 minutes per scan, demonstrated full confidence in 93%, and rated the quality as excellent in 76%. CONCLUSION For focused assessment of renal vascular and urographic anatomy, review of 3D data set alone provides high sensitivity and specificity with regard to findings seen at surgery.
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Affiliation(s)
- Neeraj Rastogi
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA
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23
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Beier UH, John E, Lumpaopong A, Co JG, Jelnin V, Benedetti E, Testa G, Bottke R, Sharon BI, Ruiz CE. Electron-beam CT as a diagnostic modality in pediatric nephrology and renal transplant surgery. Pediatr Nephrol 2006; 21:677-82. [PMID: 16520947 DOI: 10.1007/s00467-006-0045-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 10/26/2005] [Accepted: 11/22/2005] [Indexed: 11/27/2022]
Abstract
Electron-beam computed tomography is an imaging technology with a variety of medical applications, primarily in cardiology due to its sub-second acquisition time enabling visualization of a beating heart. Recently, this technique has also been introduced into other fields because of lower radiation exposure compared to traditional computed tomography, as well as the strengths of post-procedural three-dimensional visualization. This report evaluates electron-beam computed tomography as a diagnostic modality in pediatric nephrology patients. Seven patients reflecting typical clinical scenarios in pediatric nephrology were reviewed with regard to the value of electron-beam computed tomography and its contribution to the diagnostic workup. Electron-beam computed tomography is noninvasive and allows three-dimensional post-processing, enabling highly accurate images while requiring less radiation and acquisition time. It is very useful for clinical questions that require a detailed description of vascular and renal anatomy.
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Affiliation(s)
- Ulf H Beier
- Department of Pediatrics, University of Illinois at Chicago, 840 South Wood Street, Room 1438 CSB, Chicago, IL 60612-7324, USA.
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24
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Droupy S, Eschwège P, Hammoudi Y, Durrbach A, Charpentier B, Benoit G. Consequences of Iliac Arterial Atheroma on Renal Transplantation. J Urol 2006; 175:1036-9. [PMID: 16469611 DOI: 10.1016/s0022-5347(05)00325-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE Because recipient age has significantly increased in the last 15 years, surgeons must sometimes deal with atherosclerotic lesions of the iliac arterial system. Arterial restoration during renal transplantation should now be less frequent due to better preoperative screening and the prevention of arteriosclerosis in patients on renal transplantation waiting lists but in some patients EIA atheroma may require an additional surgical vascular procedure during renal transplantation. We describe the role of iliac artery atherosclerosis and the technical aspects of arterial restoration performed in patients who have undergone renal transplantation since 1985. MATERIALS AND METHODS In a series of 1,110 cadaveric renal transplantations performed between 1985 and 2000, 38 patients required endarterectomy during renal transplantation and 69 were considered not to require any special procedure. RESULTS In the 38 patients requiring endarterectomy a total of 12 end-to-end arterial anastomoses were performed and 6 ASs (50%) were observed, while 26 side-to-end arterial anastomoses were performed with only 1 AS (4%). Patient and graft survival curves showed a significant negative correlation with the severity of atherosclerosis. CONCLUSIONS Preoperative assessment of the EIA is mandatory before renal transplantation. Renal transplantation can be performed in patients with an atheromatous EIA if the artery can be clamped for endarterectomy. In our experience side-to-end anastomosis using a donor patch onto the EIA provides better results by avoiding AS after endarterectomy. However, despite vascular repair graft survival is significantly lower in patients with atheromatous lesions requiring endarterectomy.
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Affiliation(s)
- Stéphane Droupy
- Department of Urology, Hospital de Bicêtre, University Paris Sud, Le Kremlin-Bicêtre, France.
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