Imaging non-vascular complications of renal transplantation
Tóm tắt
In patients with end-stage renal disease, the treatment of choice for most patients is renal transplantation. Complications that occur after kidney transplant can be broadly divided into vascular and non-vascular categories. Non-vascular complications can further be divided into surgical and medical categories. When evaluating renal transplant imaging, it is helpful to consider the occurrence of complications in a timeline from time of surgery. Ultrasound is often the first modality used for evaluation of renal transplants particularly in the early postoperative period. Contrast-enhanced ultrasound can be a helpful adjunct in evaluating certain complications such as hematoma, rejection, and infection. Computed tomography (CT) is also helpful in accurately diagnosing complications. Surgical complications include perinephric fluid collections (hematoma, urinoma from urine leak, abscess, and lymphocele), urinary obstruction, and incisional fluid collections and hernias. One major category of medical complications that affect the renal parenchyma includes rejection (hyperacute, acute, and chronic), delayed graft function, acute tubular necrosis (ATN), and nephrotoxicity. Infection, renal calculi, and neoplasms such as post-transplant lymphoproliferative disease are medical complications that occur after renal transplantation. It is important for radiologists to be aware of the ultrasound and CT findings of the surgical and medical complications after renal transplant for prompt identification and treatment.
Tài liệu tham khảo
U.S. Department of Health and Human Services (2017) Organ Procurement and Transplantation Network National Data. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed 13 Dec2017
Inci MF, Ozkan F, See TC, Tatli S (2014) Renal transplant complications: diagnostic and therapeutic role of radiology. Can Assoc Radiol J 65(3):242–252. https://doi.org/10.1016/j.carj.2013.06.002
Fananapazir G, Rao R, Corwin MT, et al. (2015) Sonographic evaluation of clinically significant perigraft hematomas in kidney transplant recipients. AJR Am J Roentgenol 205(4):802–806. https://doi.org/10.2214/AJR.15.14426
Heffernan E, Zwirewich C, Harris A, Nguan C (2009) Page kidney after renal allograft biopsy: sonographic findings. J Clin Ultrasound 37(4):226–229. https://doi.org/10.1002/jcu.20465
Grzelak P, Kurnatowska I, Nowicki M, et al. (2013) The diagnostic value of contrast-enhanced ultrasonography in the assessment of perirenal hematomas in the early post-operative period after kidney transplantation. Clin Transpl 27(6):E619–E624. https://doi.org/10.1111/ctr.12257
Kolli KP, LaBerge JM (2016) Interventional management of nonvascular renal transplant complications. Tech Vasc Interv Radiol 19(3):218–227. https://doi.org/10.1053/j.tvir.2016.06.007
Fontaine AB, Nijjar A, Rangaraj R (1997) Update on the use of percutaneous nephrostomy/balloon dilation for the treatment of renal transplant leak/obstruction. J Vasc Interv Radiol 8(4):649–653. https://doi.org/10.1016/s1051-0443(97)70625-0
Hedegard W, Saad WE, Davies MG (2009) Management of vascular and nonvascular complications after renal transplantation. Tech Vasc Interv Radiol 12(4):240–262. https://doi.org/10.1053/j.tvir.2009.09.006
Kobayashi K, Censullo M, Rossman L, et al. (2007) Interventional radiologic management of renal transplant dysfunction- indications, limitations, and technical considerations. RadioGraphics 27:1109–1130
Akbar S, Jafri Z, Amendola M, et al. (2005) Complications of renal transplantation. RadioGraphics 25:1335–1356
Golriz M, Klauss M, Zeier M, Mehrabi A (2017) Prevention and management of lymphocele formation following kidney transplantation. Transpl Rev (Orlando) 31(2):100–105. https://doi.org/10.1016/j.trre.2016.11.001
Sui W, Lipsky MJ, Matulay JT, et al. (2017) Timing and predictors of early urologic and infectious complications after renal transplant: an analysis of a New York statewide database. Exp Clin Transpl . https://doi.org/10.6002/ect.2016.0357
Moreno CC, Mittal PK, Ghonge NP, Bhargava P, Heller MT (2016) Imaging complications of renal transplantation. Radiol Clin North Am 54(2):235–249. https://doi.org/10.1016/j.rcl.2015.09.007
Dalgic A, Boyvat F, Karakayali H, et al. (2006) Urologic complications in 1523 renal transplantations: the Baskent University experience. Transpl Proc 38(2):543–547. https://doi.org/10.1016/j.transproceed.2005.12.116
Knight RJ, Villa M, Laskey R, et al. (2007) Risk factors for impaired wound healing in sirolimus-treated renal transplant recipients. Clin Transpl 21(4):460–465. https://doi.org/10.1111/j.1399-0012.2007.00668.x
Ooms LS, Verhelst J, Jeekel J, et al. (2016) Incidence, risk factors, and treatment of incisional hernia after kidney transplantation: an analysis of 1,564 consecutive patients. Surgery 159(5):1407–1411. https://doi.org/10.1016/j.surg.2015.11.017
Li EN, Silverman RP, Goldberg NH (2005) Incisional hernia repair in renal transplantation patients. Hernia 9(3):231–237. https://doi.org/10.1007/s10029-005-0325-y
Friedewald S, Molmenti E, Friedewald J, DeJong M, Hamper U (2005) Vascular and nonvascular complications of renal transplants- sonographic evaluation and correlation with other imaging modalities, surgery, and pathology. J Clin Ultrasound 33(3):127–139. https://doi.org/10.1002/jcu
Venz S, Kahl A, Hierholzer J, et al. (1999) Contribution of color and power Doppler sonography to the differential diagnosis of acute and chronic rejection, and tacrolimus nephrotoxicity in renal allografts. Transpl Int 12:127–134
Schwenger V, Korosoglou G, Hinkel UP, et al. (2006) Real-time contrast-enhanced sonography of renal transplant recipients predicts chronic allograft nephropathy. Am J Transpl 6(3):609–615. https://doi.org/10.1111/j.1600-6143.2005.01224.x
Benozzi L, Cappelli G, Granito M, et al. (2009) Contrast-enhanced sonography in early kidney graft dysfunction. Transpl Proc 41(4):1214–1215. https://doi.org/10.1016/j.transproceed.2009.03.029
Zeisbrich M, Kihm LP, Druschler F, Zeier M, Schwenger V (2015) When is contrast-enhanced sonography preferable over conventional ultrasound combined with Doppler imaging in renal transplantation? Clin Kidney J 8(5):606–614. https://doi.org/10.1093/ckj/sfv070
Kazmierski B, Deurdulian C, Tchelepi H, Grant EG (2017) Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol (NY) . https://doi.org/10.1007/s00261-017-1307-0
Humar A, Ramcharan T, Kandaswamy R, et al. (2002) Risk factors for slow graft function after kidney transplants: a multivariate analysis. Clin Transpl 16(6):425–429
Ojo AO, Wolfe RA, Held PJ, Port FK, Schmouder RL (1997) Delayed graft function: risk factors and implications for renal allograft survival. Transplantation 63(7):968–974
Singh R, Geerlings SE, Peters-Sengers H, et al. (2016) Incidence, risk factors, and the impact of allograft pyelonephritis on renal allograft function. Transpl Infect Dis 18(5):647–660. https://doi.org/10.1111/tid.12568
Rubin RH (1993) Infectious disease complications of renal transplantation. Kidney International 44(1):221–236. https://doi.org/10.1038/ki.1993.234
Schmaldienst S, Dittrich E, Horl W (2002) Urinary tract infections after renal transplantation. Curr Opin Urol 12:125–130
Eggli KD, Eggli D (1992) Color Doppler sonography in pyelonephritis. Pediatr Radiol 22(6):422–425
Granata A, Andrulli S, Fiorini F, et al. (2011) Diagnosis of acute pyelonephritis by contrast-enhanced ultrasonography in kidney transplant patients. Nephrol Dial Transpl 26(2):715–720. https://doi.org/10.1093/ndt/gfq417
Weber TM, Lockhart ME (2013) Renal transplant complications. Abdom Imaging 38(5):1144–1154. https://doi.org/10.1007/s00261-013-0005-9
Rubens DJ, Bhatt S, Nedelka S, Cullinan J (2006) Doppler artifacts and pitfalls. Radiol Clin North Am 44(6):805–835. https://doi.org/10.1016/j.rcl.2006.10.014
Krambeck AE, Leroy AJ, Patterson DE, Gettman MT (2008) Percutaneous nephrolithotomy success in the transplant kidney. J Urol 180(6):2545–2549. https://doi.org/10.1016/j.juro.2008.08.032
Vajdic C, McDonald S, McCredie M, et al. (2006) Cancer Incidence before and after kidney transplantation. JAMA 296(23):2823–2831
Engels EA, Pfeiffer RM, Fraumeni JF Jr, et al. (2011) Spectrum of cancer risk among US solid organ transplant recipients. JAMA 306(17):1891–1901. https://doi.org/10.1001/jama.2011.1592
Hoover R, Fraumeni JF Jr (1973) Risk of cancer in renal-transplant recipients. Lancet 302(7820):55–57
Newstead C (2000) Lymphoproliferative disease post-renal transplantation. Nephrol Dial Transpl 15:1913–1916
Taylor AL, Marcus R, Bradley JA (2005) Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol 56(1):155–167. https://doi.org/10.1016/j.critrevonc.2005.03.015
Hosseini-Moghaddam SM, Alhomayeed B, Soliman N, Weir MA, House AA (2016) Primary Epstein–Barr virus infection, seroconversion, and post-transplant lymphoproliferative disorder in seronegative renal allograft recipients: a prospective cohort study. Transpl Infect Dis 18(3):423–430. https://doi.org/10.1111/tid.12533
Vrachliotis T, Vaswani K, Davies E, et al. (2000) CT findings in posttransplantation lymphoproliferative disorder of renal transplants. AJR Am J Roentgenol 175:183–188