Diagnostic Ultrasound - Abdomen and Pelvis

Delayed Renal Graft Function
TERMINOLOGY
Abbreviations
• Delayed graft function (DGF)
Definitions
• Oliguria, poor clearance, and need for dialysis in 1st week
after transplantation
IMAGING
General Features
• Best diagnostic clue
○ Clinical diagnosis with no specific imaging findings
Ultrasonographic Findings
• Renal transplant may be edematous
• May have elevated resistive indices or absence of diastolic
flow
• Look for hemorrhage, vascular thrombosis, or
hydronephrosis
Nuclear Medicine Findings
• Normal perfusion with accumulation of activity in renal
parenchyma using Tc-99m mertiatide
• Minimal if any excretion
Imaging Recommendations
• Best imaging tool
○ Doppler ultrasound to exclude other causes of renal
transplant dysfunction
DIAGNOSTIC CHECKLIST
Consider
• Early biopsy (3-5 days in high-risk patients) to detect
coexisting early rejection
SELECTED REFERENCES
1. Granata A et al: Renal transplant vascular complications: the role of Doppler
ultrasound. J Ultrasound. 18(2):101-7, 2015
2. Granata A et al: Renal transplantation parenchymal complications: what
Doppler ultrasound can and cannot do. J Ultrasound. 18(2):109-16, 2015
3. Ninet S et al: Doppler-based renal resistive index for prediction of renal
dysfunction reversibility: A systematic review and meta-analysis. J Crit Care.
30(3):629-35, 2015
4. Shakeri Bavil A et al: The inability of an early post-transplantation intrarenal
resistive index to predict renal allograft function at 12 weeks after
engraftment in young adults. Acta Radiol. ePub, 2015
5. Cano H et al: Resistance index measured by Doppler ultrasound as a
predictor of graft function after kidney transplantation. Transplant Proc.
46(9):2972-4, 2014
6. Rodgers SK et al: Ultrasonographic evaluation of the renal transplant. Radiol
Clin North Am. 52(6):1307-24, 2014
7. Schwenger V et al: Contrast-enhanced ultrasonography in the early period
after kidney transplantation predicts long-term allograft function.
Transplant Proc. 46(10):3352-7, 2014
8. Uliel L et al: Nuclear medicine in the acute clinical setting: indications,
imaging findings, and potential pitfalls. Radiographics. 33(2):375-96, 2013
9. Cosgrove DO et al: Renal transplants: what ultrasound can and cannot do.
Ultrasound Q. 24(2):77-87; quiz 141-2, 2008
Diagnoses: Kidney Transplant
PATHOLOGY
General Features
• Etiology
○ Ischemia/reperfusion injury resulting in tubular damage
Risk Factors
• Donor: Age, cause of death, comorbidities
• Injury at procurement, organ preservation methods, warm
and cold ischemia time
CLINICAL ISSUES
Presentation
• Most common signs/symptoms
○ Oliguria, lack of renal function
Demographics
• Epidemiology
○ 21% incidence in deceased donor transplantation, 2-5%
after living donor transplantation
○ < 5% of kidneys never function: Primary nonfunction
• Most common cause is acute tubular necrosis: 70-90%
Natural History & Prognosis
• Significant impact on long-term graft and patient survival
• Increased incidence of acute rejection
• May be complicated by vascular thrombosis
Treatment
• Supportive with dialysis as needed
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