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Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes

Received: 31 December 2016    Accepted: 25 January 2017    Published: 25 March 2017
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Abstract

Objective: Fast MR imaging sequences together with paramagnetic contrast agents, offer multiple advantages in the assessment of renal function. It provides cross sectional and vascular information without the risk of ionizing radiation, iodinated contrast or arterial catheterization. Post transplantation complications can be grouped as surgical or medical. Immediate surgical complications include renal artery thrombosis or stenosis, urinary leak or lymphocele. Renal allograft frequently require repeated imaging studies during the immediate post-operative period and various times thereafter, when renal function is compromised. Background: End stage renal disease is common and can result from a variety of diseases. Kidney transplantation from living-related donors offered the best prognosis. Imaging modalities that are currently used to evaluate transplanted kidneys are ultrasound (US), computed tomography (CT), scintigraphy, intravenous urography (IVU), contrast angiography, and magnetic resonance imaging (MRI). Methods: This study was conducted on 181 renal transplant recipients. Recipients were 139 males and 42 females. Their age ranged from 20 to 58 years (mean age 39 years). The patients underwent clinical assessment, Laboratory investigations, and different Radiological imaging procedures as: I- Gray scale and color Doppler ultrasonography. II- Magnetic Resonance Imaging. 3D Gd-enhanced MRA. MR Urography. Selective IA-DSA of the graft artery. III- Percutaneous catheter nephrostomy (PCN) and antegrade pyelography. IV- Radio-isotope diuretic renogram using 99m Tc-MAG3. Results: 30 renal transplants were examined by MRI in the 1st 2 weeks after renal transplantation. At the end of 1st 2 weeks, MR examinations were carried out, as basal studies (including MRI, MRA and MRU) for 98 transplants. From this group, 64 transplants were subjected to other MR examinations. After the 1st 2 weeks, 53 transplants were subjected to MR examinations for the 1st time at variable post-transplant duration. Among the studied 181 renal transplants, MR examinations detected 3 cases with graft arteries thrombosis (1.6%), 10 with graft arteries stenosis (5.5%), 6 with segmental infarctions (3.3%), 3 cases with graft intrarenal arteries pseudo-aneurysms (1.6%) and 2 cases with arterio- venous fistulae (1.1%) after graft biopsies. Conclusion: MRI is highly recommended to evaluate intra-/extra-renal graft vascular lesions, urinary obstructive syndrome, compressive collections (urinoma, lymphocele), inflammatory and tumoral lesions of the renal graft.

Published in International Journal of Medical Imaging (Volume 5, Issue 2)
DOI 10.11648/j.ijmi.20170502.14
Page(s) 26-33
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Magnetic Resonance Imaging, Diuretic Renogram , Antegrade Pyelography , Renal Transplant, Surgical Complications

References
[1] Onniboni M, R, Coco L, Zompatori M, Sverzellati N, Rossi C.: Magnetic resonance imaging in the complications of kidney transplantation. Radiol Med. Oct 22, 2012.
[2] Barry JM, Conlin MJ. Renal transplantation. In: Wein AJ, editor. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; p. 1279_1289. 2011.
[3] Lamb KE, Lodhi S, Meier-Kriesche HU: Long-term renal allograft survival in the United States: A critical reappraisal. Am. J. Transplant.; 11: 450-462. 2011.
[4] Hohenwalter M. D, Skowlund C. J., Erickson S. J, Hariharan S, Rilling W. S., Crain M. R., and Drescher P.: Renal transplant evaluation with MR angiography and MR imaging. Radiographics, 21, (6), 1505-1517, 2001.
[5] Choyke, P. L., Becker, J. A., and Zeissman, H. A.: Imaging the transplanted kidney in: Pollack, H. M., and Mcclennan, B. L., eds): Clinical urography 2nd edition. Vol (3), Ch, (106), W. B Saunders, Philadelphia: 3091-3118, 2000.
[6] Akbar SA, Jafri SZ, Amendola MA, Madrazo BL, Salem R, Bis KG.: Complications of renal transplantation. Radiographics 25: 1335–1356, 2005.
[7] Safa J, Nezami N, Tarzamni M. K., Zarforooshan S, Rahimi-Ardabili B and Bohlouli A.: Post-transplant urological and vascular complications. Saudi Journal of Kidney Disease Transplantation, 20 (5): 867-71, 2009.
[8] Liu X, Berg N, Sheehan J, et al. Renal Transplant: Nonenhanced Renal MR Angiography with Magnetization-prepared Steady-State Free Precession 1. Radiology; 251: 535-542. 2009.
[9] Aneesh Srivastava, Jatinder Kumar, Sandeep Sharma, Abhishek, MS Ansari, and Rakesh Kapoor. Vascular complication in live related renal transplant: An experience of 1945 cases. Indian J Urol. Jan-Mar; 29 (1): 42–47. 2013.
[10] Huber H., Heuck A., Scheidler J., Holzknecht N., Baur A., Stangl M., Theodorakis J., D-Illner W., Land W. and Reiser M.: Contrast-enhanced MR Aniography in patients after kidney transplantation. Eur. Radiol. 11: 2488-2495, 2001.
[11] Hany T. F., Schmidt M., Davis C. P. Göhde S. C. and Debatin J. F.: Diagnostic impact of four post-processing techniques in evaluating contrast enhanced 3D-MRA. AJR. 170: 907-912.1998.
[12] Claus C. A., Adam G. B. and Günther R. W.: MR urography: examination techniques and clinical applications. Eur. Radiol, 11: 355-372, 2001.
[13] Schubert R. A., Gockeritz S., Mentzel H. J., Rzanny R., Schubert J. and Kaiser W. A.: Imaging in ureteral complications of renal transplantation: value of static fluid MR urography. Eur. Radiol. 10 (7): 1152-1157, 2000.
[14] Lupescu IG, Capsa RA, Popa GA, Medar C, Nicolae AC, Preda EM, Flintoaca A, Lesaru M, Sinescu I. CT and MRI diagnostic value of renal posttransplant complications- experience of Fundeni Clinical Institute. XIXth Romanian Congress of Radiology and Medical Imaging, Bucharest, 11-13 October, 2013.
[15] Nixon JN, Biyyam DR, Stanescu L, Phillips GS, Finn LS, Parisi MT. Imaging of Pediatric Renal Transplants and Their Complications: A Pictorial Review. RadioGraphics, 33: 1227-1251, 2013.
[16] Fang Y. C., and Siegelman E. S.: Complications of Renal transplantation: MR findings. Journal of computer Assistant Tomography. 25 (6): 836-842, 2001.
[17] Boeve W. J, Kok T, Tegzess, A. M., Van son, W. J, Ploeg R. J,. Sluiter W. J., and Kamman R. L: Comparison of contrast enhanced MR angiography- MRI and digital subtraction angiography in the evaluation of pancreas and/or kidney transplantation patients: Initial experience. Magn. Reson. Imaging. 19 (5): 595-607. 2001.
[18] Irtan S, Maisin A, Baudouin V, Nivoche Y, Azoulay R, Jacqz E, and Aigrain Y.: Renal transplantation in children: Critical analysis of age related surgical complications. Pediatric Transplant. Jan 11, 2010.
[19] Luk S. H., Chan J. H. wan T. H, Tsui W. C., Cheung Y. K. and Yuen M. K.: Breath-hold 3D-Gd-enhanced subtraction MRA in the detection of transplant renal artery stenosis. Clin. Radiol. 54 (10): 651-654, 1999.
[20] Dunnick N. R., Sandler C. M. and Newhouse J. H.: Renal transplantation in: Text book of uroradiology. Ch. (12): 242. Lippincot Williams and Wilkins. 2001.
[21] Sato N., Kobayashi H., Hiraga A., Saga T., Togashi K., Konishi J., and Brechbiel M. W.: Pharmacokinetics and enhancement patterns of macromolecular MR contrast agents with various sizes of polyamidoamine dendrimer cores. Magn. Reson. Med. 46 (6): 1169-1173. 2001.
[22] Heverhagen J. T., Funck R. C., Schwarz U.,. Zoefel P., Matschl V., Klose K. J. and Wagner H. J: Kinetic evaluation of an I. V bolus of MR contrast media. Magn. Reson. Imaging. 19 (7): 1025-1030. 2001.
[23] EL-Diasty T, Ateia M, and Kamal T; Comprehensive MR Evaluation of potential kidney transplant donors. European society of urogenital Radiology meeting (ESUR 2000). Eur. Radiol. 10, abstracts): E1 – E26. 2000.
[24] Hany T. F., Schmidt M., Da Fervenza F. C., Lafayette R. A, Alfery E. J. and Petersen J.: Renal artery stenosis in kidney transplantation. Am. J. kidney. Dis. 31: 142-148. 1998..
[25] Namimito T., Yamashita, Y. Mitsuzaki K., Nakayama Y., Tango Y. and Takahashi M.: Measurement of the apparent diffusion coefficient in diffuse renal diseases by diffusion weighted echo-planar imaging. J. MRI. 9: 832-837, 1999.
[26] Bracale UM, Carbone F, del Guercio L, Viola D, D Armiento FP, Maurea S, et al. External iliac artery pseudoaneurysm complicating renal transplantation. Interact Cardiovasc Thorac Surg.; 8: 654–60, 2009.
[27] Poels JA, Riley PL. Extrarenal transplant artery pseudoaneurysm: A combined therapeutic approach. Cardiovasc Intervent Radiol.; 31: 404, 2008.
[28] Womer KL, Kaplan B: Recent developments in kidney transplantation; A critical assessment. Am J Transplant; 9: 1265-1271, 2009.
[29] Schenk, J. P, Hansmann J, Hallscheidt P, Weingard K., Wiesel, M., Leutloff C. U., Dux, M., Richter, G. M., and Kauffmann, G. W: Radiodiagnosis following kidney transplantation. Radiology, 39; 404-414, 1999.
[30] Ngai S, Demetriades T: Prediction of long-term renal transplant allograft function from day 3 post-transplant Tc-99m MAG3 scintigraphy. Clin Nucl Med; 33: 102-105, 2008.
[31] Guignard R, Mourad G, Mariano-Goulart D: Utility of postsurgical renal scintigraphy to predict one-year outcome of renal transplants in patients with delayed graft function. Nucl Med Commun; 32: 314-319, 2011.
[32] Gupta SK, Lewis G, Rogers K, et al: Quantitative Tc-99m DTPA renal transplant scintigraphy predicts graft survival in the very early post- operative period. Nucl Med Commun; 33: 1292-1299, 2012.
[33] Grenier N, Merville P and Pasticier G. Renal Transplantation: Epidemiological, Clinical, Radiological and Surgical Considerations, in Imaging in Transplantation, Springer, 55-98, 2008.
[34] Thoeny HC, De Keyzer F. Diffusion-weighted MR Imaging of Native and Transplanted Kidneys. Radiology, 259: 25-38, 2011.
[35] Prabhakar Rajiah, Yit Yoo Lim, Paul Taylor: Renal transplant imaging & complications, Abdom. Imaging (2006) 31: 735-746, published online 21 February 2007.
[36] Martin DR, Sharma P, Salman K, Jones RA, Grattan-Smith JD, Mao H, Lauenstein TC, Burrow BK, Dana LRT.: Tudorascu and Votaw JR: Individual Kidney Blood Flow Measured with Contrast enhanced First-Pass Perfusion MR Imaging. Radiology: 246: 1; 241: 248, 2008.
[37] Humar A, Matas AJ.: Surgical complications after kidney transplantation. Semin Dial 18: 505–510, 2005.
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    Tarek Fawzy Abd Ella, Waleed Abdelfattah Mousa. (2017). Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes. International Journal of Medical Imaging, 5(2), 26-33. https://doi.org/10.11648/j.ijmi.20170502.14

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    Tarek Fawzy Abd Ella; Waleed Abdelfattah Mousa. Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes. Int. J. Med. Imaging 2017, 5(2), 26-33. doi: 10.11648/j.ijmi.20170502.14

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    AMA Style

    Tarek Fawzy Abd Ella, Waleed Abdelfattah Mousa. Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes. Int J Med Imaging. 2017;5(2):26-33. doi: 10.11648/j.ijmi.20170502.14

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  • @article{10.11648/j.ijmi.20170502.14,
      author = {Tarek Fawzy Abd Ella and Waleed Abdelfattah Mousa},
      title = {Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes},
      journal = {International Journal of Medical Imaging},
      volume = {5},
      number = {2},
      pages = {26-33},
      doi = {10.11648/j.ijmi.20170502.14},
      url = {https://doi.org/10.11648/j.ijmi.20170502.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmi.20170502.14},
      abstract = {Objective: Fast MR imaging sequences together with paramagnetic contrast agents, offer multiple advantages in the assessment of renal function. It provides cross sectional and vascular information without the risk of ionizing radiation, iodinated contrast or arterial catheterization. Post transplantation complications can be grouped as surgical or medical. Immediate surgical complications include renal artery thrombosis or stenosis, urinary leak or lymphocele. Renal allograft frequently require repeated imaging studies during the immediate post-operative period and various times thereafter, when renal function is compromised. Background: End stage renal disease is common and can result from a variety of diseases. Kidney transplantation from living-related donors offered the best prognosis. Imaging modalities that are currently used to evaluate transplanted kidneys are ultrasound (US), computed tomography (CT), scintigraphy, intravenous urography (IVU), contrast angiography, and magnetic resonance imaging (MRI). Methods: This study was conducted on 181 renal transplant recipients. Recipients were 139 males and 42 females. Their age ranged from 20 to 58 years (mean age 39 years). The patients underwent clinical assessment, Laboratory investigations, and different Radiological imaging procedures as: I- Gray scale and color Doppler ultrasonography. II- Magnetic Resonance Imaging. 3D Gd-enhanced MRA. MR Urography. Selective IA-DSA of the graft artery. III- Percutaneous catheter nephrostomy (PCN) and antegrade pyelography. IV- Radio-isotope diuretic renogram using 99m Tc-MAG3. Results: 30 renal transplants were examined by MRI in the 1st 2 weeks after renal transplantation. At the end of 1st 2 weeks, MR examinations were carried out, as basal studies (including MRI, MRA and MRU) for 98 transplants. From this group, 64 transplants were subjected to other MR examinations. After the 1st 2 weeks, 53 transplants were subjected to MR examinations for the 1st time at variable post-transplant duration. Among the studied 181 renal transplants, MR examinations detected 3 cases with graft arteries thrombosis (1.6%), 10 with graft arteries stenosis (5.5%), 6 with segmental infarctions (3.3%), 3 cases with graft intrarenal arteries pseudo-aneurysms (1.6%) and 2 cases with arterio- venous fistulae (1.1%) after graft biopsies. Conclusion: MRI is highly recommended to evaluate intra-/extra-renal graft vascular lesions, urinary obstructive syndrome, compressive collections (urinoma, lymphocele), inflammatory and tumoral lesions of the renal graft.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Post Renal Transplant Surgical Complications; MRI Standard Applications and Diagnostic Outcomes
    AU  - Tarek Fawzy Abd Ella
    AU  - Waleed Abdelfattah Mousa
    Y1  - 2017/03/25
    PY  - 2017
    N1  - https://doi.org/10.11648/j.ijmi.20170502.14
    DO  - 10.11648/j.ijmi.20170502.14
    T2  - International Journal of Medical Imaging
    JF  - International Journal of Medical Imaging
    JO  - International Journal of Medical Imaging
    SP  - 26
    EP  - 33
    PB  - Science Publishing Group
    SN  - 2330-832X
    UR  - https://doi.org/10.11648/j.ijmi.20170502.14
    AB  - Objective: Fast MR imaging sequences together with paramagnetic contrast agents, offer multiple advantages in the assessment of renal function. It provides cross sectional and vascular information without the risk of ionizing radiation, iodinated contrast or arterial catheterization. Post transplantation complications can be grouped as surgical or medical. Immediate surgical complications include renal artery thrombosis or stenosis, urinary leak or lymphocele. Renal allograft frequently require repeated imaging studies during the immediate post-operative period and various times thereafter, when renal function is compromised. Background: End stage renal disease is common and can result from a variety of diseases. Kidney transplantation from living-related donors offered the best prognosis. Imaging modalities that are currently used to evaluate transplanted kidneys are ultrasound (US), computed tomography (CT), scintigraphy, intravenous urography (IVU), contrast angiography, and magnetic resonance imaging (MRI). Methods: This study was conducted on 181 renal transplant recipients. Recipients were 139 males and 42 females. Their age ranged from 20 to 58 years (mean age 39 years). The patients underwent clinical assessment, Laboratory investigations, and different Radiological imaging procedures as: I- Gray scale and color Doppler ultrasonography. II- Magnetic Resonance Imaging. 3D Gd-enhanced MRA. MR Urography. Selective IA-DSA of the graft artery. III- Percutaneous catheter nephrostomy (PCN) and antegrade pyelography. IV- Radio-isotope diuretic renogram using 99m Tc-MAG3. Results: 30 renal transplants were examined by MRI in the 1st 2 weeks after renal transplantation. At the end of 1st 2 weeks, MR examinations were carried out, as basal studies (including MRI, MRA and MRU) for 98 transplants. From this group, 64 transplants were subjected to other MR examinations. After the 1st 2 weeks, 53 transplants were subjected to MR examinations for the 1st time at variable post-transplant duration. Among the studied 181 renal transplants, MR examinations detected 3 cases with graft arteries thrombosis (1.6%), 10 with graft arteries stenosis (5.5%), 6 with segmental infarctions (3.3%), 3 cases with graft intrarenal arteries pseudo-aneurysms (1.6%) and 2 cases with arterio- venous fistulae (1.1%) after graft biopsies. Conclusion: MRI is highly recommended to evaluate intra-/extra-renal graft vascular lesions, urinary obstructive syndrome, compressive collections (urinoma, lymphocele), inflammatory and tumoral lesions of the renal graft.
    VL  - 5
    IS  - 2
    ER  - 

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Author Information
  • Department of Diagnostic Radiology, Menoufia University, Menoufia, Egypt

  • Department of Diagnostic Radiology, Menoufia University, Menoufia, Egypt

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