TRANSPLANT KIDNEY ULTRASOUND: COMMON PATHOLOGY AND LEARNING POINTS
By Carys Doull, University Hospital Wales
Introduction:
Kidneys are the most commonly transplanted solid organ and transplant is the only definitive treatment for end-stage-kidney failure. Common causes for end-stage-kidney disease that require transplant include hypertension, diabetes, chronic glomerulonephritis and polycystic kidney disease.
Surgical Technique:
Variations in donor arterial, venous, and ureteral anatomy are important factors that influence the surgical technique and placement of the donor kidney. However, the donor kidney is most commonly placed in the extraperitoneal space, within the right iliac fossa.
Anastomoses are made between the renal artery of the donor kidney and the recipient iliac artery, the renal vein of the donor kidney and the recipient iliac vein and the donor ureter and recipient bladder. Ultrasound is a non-invasive, diagnostic examination which can assess the shape, size, echogenicity and vascularity of the kidney post-transplant.
Complications:
The four types of perinephric fluid collections post-transplant which can be visualised on ultrasound include haematoma, urinoma, abscess and lymphocele. Early identification and characterisation can help guide intervention, guide treatment and management. Ultrasound doppler is another important part of the renal transplant assessment. Vascular abnormalities, global blood flow and reversal of blood flow can all be identified in the post-operative period. Ultrasound assessment of the transplant kidney also includes identification of hydronephrosis which can be evidence of strictures or obstruction.
Complications can usually be categorised into early, intermediate and late stages:
Early complications - Renal Artery Thrombosis, Renal Vein Thrombosis, Haematoma, Acute tubular necrosis.
Intermediate complications - Ureter stricture or obstruction, Urinoma, Abscess and Renal Artery Stenosis.
Late complications - Renal Neoplasm, Lymphocele and Lymphoma.
Learning points:
This poster aims to highlight the importance of ultrasound in the transplant kidney and demonstrate some of the common complications that can be seen in the early, intermediate and late stages.
