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Fernández T, Sebastià C, Paño B, Corominas Muñoz D, Vas D, García-Roch C, Revuelta I, Musquera M, García F, Nicolau C. Contrast-enhanced US in Renal Transplant Complications: Overview and Imaging Features. Radiographics 2024; 44:e230182. [PMID: 38781089 DOI: 10.1148/rg.230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Renal transplant is the first-line treatment of end-stage renal disease. The increasing number of transplants performed every year has led to a larger population of transplant patients. Complications may arise during the perioperative and postoperative periods, and imaging plays a key role in this scenario. Contrast-enhanced US (CEUS) is a safe tool that adds additional value to US. Contrast agents are usually administered intravenously, but urinary tract anatomy and complications such as stenosis or leak can be studied using intracavitary administration of contrast agents. Assessment of the graft and iliac vessels with CEUS is particularly helpful in identifying vascular and parenchymal complications, such as arterial or venous thrombosis and stenosis, acute tubular injury, or cortical necrosis, which can lead to graft loss. Furthermore, infectious and malignant graft involvement can be accurately studied with CEUS, which can help in detection of renal abscesses and in the differentiation between benign and malignant disease. CEUS is also useful in interventional procedures, helping to guide percutaneous aspiration of collections with better delimitation of the graft boundaries and to guide renal graft biopsies by avoiding avascular areas. Potential postprocedural vascular complications, such as pseudoaneurysm, arteriovenous fistula, or active bleeding, are identified with CEUS. In addition, newer quantification tools such as CEUS perfusion are promising, but further studies are needed to approve its use for clinical purposes. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Tomás Fernández
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carmen Sebastià
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Blanca Paño
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Daniel Corominas Muñoz
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Daniel Vas
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carmen García-Roch
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Ignacio Revuelta
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Mireia Musquera
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Fernando García
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carlos Nicolau
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
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Puliyanda D, Barday Z, Barday Z, Freedman A, Todo T, Chen AKC, Davidson B. Children Are Not Small Adults: Similarities and Differences in Renal Transplantation Between Adults and Pediatrics. Semin Nephrol 2023; 43:151442. [PMID: 37949683 DOI: 10.1016/j.semnephrol.2023.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Kidney transplantation is the treatment of choice for all patients with end-stage kidney disease, including pediatric patients. Graft survival in pediatrics was lagging behind adults, but now is comparable with the adult cohort. Although many of the protocols have been adopted from adults, there are issues unique to pediatrics that one should be aware of to take care of this population. These issues include recipient size consideration, increased incidence of viral infections, problems related to growth, common occurrence of underlying urological issues, and psychosocial issues. This article addresses the similarities and differences in renal transplantation, from preparing a patient for transplant, the transplant process, to post-transplant complications.
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Affiliation(s)
- Dechu Puliyanda
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA.
| | - Zibya Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Zunaid Barday
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Freedman
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Tsuyoshi Todo
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Allen Kuang Chung Chen
- Pediatric Nephrology and Comprehensive Transplant Program, Cedars Sinai Medical Center, Los Angeles, CA
| | - Bianca Davidson
- Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Bañuelos Marco B, Donmez I, Geppert T, Prudhomme T, Campi R, Mesnard B, Hevia V, Boissier R, Pecoraro A, Territo A. Renal transplantation in pediatric recipients: Considerations and preoperative assessment strategies. Actas Urol Esp 2023:S2173-5786(23)00038-0. [PMID: 36965856 DOI: 10.1016/j.acuroe.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION AND OBJECTIVE Renal transplantation in the pediatric population differs from adults in many aspects. This review will focus on the unique issues of the pediatric recipient. MATERIAL AND METHODS A narrative review on the scarce literature regarding preoperative evaluation before kidney transplantation of the paediatric recipient with an educational focus was conducted. The literature search allowed for identification of publications in English from January 2000 to October 2022. Published studies were identified by searching the following electronic databases: PubMed (MEDLINE), WHO/UNAIDS, Google-Scholar, Semantic-Scholar and Research Gate. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information (definitions, policies or guidelines). RESULTS Management of congenital urogenital anomalies and lower urinary tract dysfunction along with optimal pediatric urological preoperative assessment for renal transplantation in children is addressed in the light of the available literature. Furthermore, particular considerations including pre-emptive transplantation, transplantation of an adult-size kidney into an infant or small child is discussed. CONCLUSIONS Outcomes of RT in children have shown progressive improvement over the past 15 years. Transplantation with living related donor gives the best results and pre-emptive transplantation provides with benefits of avoiding dialysis. Surgical and medical considerations in both the pre-transplant and post-transplant management of the pediatric kidney recipient are extremely crucial in order to achieve better short and long-term results.
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Affiliation(s)
- B Bañuelos Marco
- Department of Urology, Renal Transplant Unit Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - I Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Estambul, Turkey
| | - T Geppert
- Division of Pediatric Urology, Department of Urology, University Hospital Charité Berlin, Berlin, Germany
| | - T Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - R Campi
- Department of Urology, Florence University Hospital, Florence, Italy
| | - B Mesnard
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - V Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Boissier
- Department of Urology, La Conception University Hospital, Marseille, France
| | - A Pecoraro
- Department of Urology, Florence University Hospital, Florence, Italy
| | - A Territo
- Oncology and Renal Transplant Units, Puigvert's Foundation, Barcelona, Spain
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Bañuelos Marco B, Bergel B, Geppert T, Müller D, Lingnau A. Introducing a New Technique for Fascial Closure to Avoid Renal Allograft Compartment Syndrome in Pediatric Recipients: The Use of Tutoplast® Fascia Lata. Front Surg 2022; 9:840055. [PMID: 35599790 PMCID: PMC9120621 DOI: 10.3389/fsurg.2022.840055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Renal allograft compartment syndrome (RACS) is a complication that infrequently occurs after renal transplantation. Tight muscle closure may lead to RACS due to compression of renal parenchyma or kinking of the renal vessels. Many techniques have been proposed in an attempt to achieve tension-free closure, which can be specially challenging in child recipients. We present our experience with Tutoplast® Fascia Lata (RTI Surgical Tutogen Medical GmbH Industriestrasse 6, 91077 Neunkirchen am Brand, Germany) closure. Methods All pediatric patients who underwent renal transplantation in our center between 2012 and 2021 were reviewed. Eight patients with Tutoplast® Fascia Lata placed at the time of initial transplantation were identified. Donor and recipient characteristics, Doppler ultrasound findings, and overall patient and graft survival rates were analyzed. Results Doppler ultrasound was performed intra-operatively after abdominal wall closure. If any sign of vascular compromise was seen, the abdominal wall was opened and the graft was revised. The Tutoplast® Fascia Lata implant was used to perform tension-free fascia closure and, afterwards, a Doppler ultrasound was performed to confirm the optimal renal artery perfusion and venous patency. Three of the renal transplantations were from a cadaver donor, with two of them en bloc. Living donor transplantation was performed in four cases. Among which, there was a case of auto-transplantation due to bilateral renal artery stenosis. None of the patients presented any complications of either short or long term that was derived from the abdominal closure with Tutoplast® Fascia Lata. There was also no record of graft failure till datum. Conclusions Restricted volume of the recipient pelvic cavity and the size discrepancy between the recipient pelvic cavity space and the donor adult kidney may lead to RACS. Other situations that occur more infrequently, i.e., as en bloc or auto-transplantation, are prone to suffer the same problem. Tutoplast® Fascia Lata is a safe option for these patients.
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Affiliation(s)
- Beatriz Bañuelos Marco
- Department Paediatric Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Beatriz Bañuelos Marco
| | | | - Tamara Geppert
- Department Paediatric Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Müller
- Department of Paediatric Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Lingnau
- Department Paediatric Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Tang L, Lee T, Yuen L, Pleass H. Renal allograft compartment syndrome: a review. ANZ J Surg 2021; 91:2606-2609. [PMID: 34755448 DOI: 10.1111/ans.17271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/29/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Renal allograft compartment syndrome (RACS) is the result of extrinsic compression resulting in graft dysfunction and loss due to ischaemia. A literature review was performed by computerized searches from the following data sources Medline, EMBASE, PubMed and Cochrane Library databases. Risk factors include size mismatch between graft and recipient. Intraoperative suspicion should be exercised if there is poor tissue turgor, cyanosis and loss of urine output upon fascial closure. Doppler ultrasound is the modality of choice amongst the literature to aid in diagnosis of RACS. From our study, the accepted form of treatment is early detection and appropriate surgical intervention. Nevertheless, it is clear from the paucity of literature that further investigation into this area of transplantation is necessary.
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Affiliation(s)
- Linda Tang
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Taina Lee
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lawrence Yuen
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Henry Pleass
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Division of Surgery, University of Sydney, Sydney, Australia
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Ghonge NP, Goyal N, Vohra S, Chowdhury V. Renal transplant evaluation: multimodality imaging of post-transplant complications. Br J Radiol 2021; 94:20201253. [PMID: 34233470 DOI: 10.1259/bjr.20201253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive "one-stop" modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist"s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Nidhi Goyal
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sandeep Vohra
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Veena Chowdhury
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
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Wagner J, Herden U, Fischer L, Schild R, Vettorazzi E, Herrmann J, Ebenebe CU, Singer D, Deindl P. Intravesical monitoring of intra-abdominal pressure after renal transplantation in children: A safety and feasibility study. Pediatr Transplant 2020; 24:e13781. [PMID: 32790967 DOI: 10.1111/petr.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
IAH after RTX can threaten graft viability. This study aimed to assess the feasibility and safety of longitudinal IAP measurements as an IAH screening method in children after RTX. A cohort of eight children with a mean ± SD [range] age 9.6 ± 6.2 [2-17] years who underwent RTX and 18 control patients were evaluated between May 2017 and February 2018. We compared longitudinal IAP measurements using a Foley manometer to other clinical monitoring data. In total, 29 IAP measurements were performed in RTX patients and 121 in controls. The mean post-operative IAP was 7.4 ± 4.3 [1-16] mm Hg following RTX and 8.1 ± 3.7 [1-19] mm Hg in controls. We noted IAH in 9 (31%) of 29 IAP measurements after RTX and in 41 (34%) of 121 IAP measurements in controls. No graft dysfunction occurred in RTX patients despite elevated IAP values. The mean ± SD [range] time expenditure for IAP measurement was 2.1 ± 0.4 [0.6-3.2] minutes. No severe complications occurred during the IAP measurements. Analysis of longitudinal IAP measurements demonstrated that IAP measurement is safe and feasible in children recovering from renal transplantation in the PICU.
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Affiliation(s)
- Jula Wagner
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Visceral Transplant Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Raphael Schild
- Department of Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Pediatric Radiology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chinedu Ulrich Ebenebe
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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8
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El-Bandar N, Lerchbaumer M, Hubatsch M, Lichy IM, Schulz MRG, Friedersdorff F. Renal Allograft Compartment Syndrome: A Case Report and Review of the Literature. Urol Int 2020; 104:646-650. [PMID: 32615567 DOI: 10.1159/000508799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022]
Abstract
Kidney transplantation is the treatment of choice for patients with ESRD. One rare complication after transplantation is the development of renal allograft compartment syndrome (RACS). We present a case of 1 patient who developed RACS due to compression of the transplant vein, which was then treated by salvaging the kidney transplant using urgent decompression surgery with mesh fascial closure. We postulate that this technique is safe and should be the treatment of choice for patients with RACS.
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Affiliation(s)
- Nasrin El-Bandar
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Markus Lerchbaumer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mandy Hubatsch
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Isabel Michaela Lichy
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias R G Schulz
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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10
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De Laet IE, Malbrain MLNG, De Waele JJ. A Clinician's Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care 2020; 24:97. [PMID: 32204721 PMCID: PMC7092484 DOI: 10.1186/s13054-020-2782-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Inneke E De Laet
- Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Campus Jette, Jette, Belgium
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
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11
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Muramatsu M, Hamasaki Y, Mizutani T, Takahashi Y, Hashimoto J, Kubota M, Oguchi H, Yonekura T, Sakurabayashi K, Aoki Y, Shinoda K, Itabashi Y, Kawamura T, Shiraga N, Mikami T, Shibuya K, Sakai K, Shishido S. Comparison of live donor predonation and post-transplant kidney volumes and glomerular size in pediatric patients weighing less than 15 kg - a retrospective study. Transpl Int 2020; 33:878-886. [PMID: 32145105 DOI: 10.1111/tri.13602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/18/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
Renal transplantation of adult-size kidneys presents a size mismatch in small children. This study presents a comparison of live donor predonation and recipient post-transplant kidney volumes (k-vol) and glomerular size at 1 year after transplantation. We analyzed 47 pediatric renal transplant recipients weighing <15 kg between 2009 and 2017. The k-vol before and 1 year after transplantation and glomerular size at implant and 1 year post-transplant were evaluated. We estimated the relationships between these changes and graft function, and the factors associated with k-vol. Pretransplant k-vol was 158.1 ± 25.1 ml, and the k-vol at 1 year post-transplant was significantly reduced by -17.2% to 132.3 ± 27.3 ml (P < 0.001). Implant glomerular size showed the diameter was 165.3 ± 15.1 µm and the area 20 737.1 ± 3230.6 µm2 . One-year post-transplant, the glomerular diameter was 150.6 ± 11.4 µm and the area 17 428.3 ± 2577.9 µm2 , significantly reduced compared with implantation values (both P < 0.001). The change in k-vol was affected by pretransplant abdominal cavity (ml/200 ml cavity volume, partial regression coefficient = 0.029, SE = 0.009, P = 0.004) and recipient's weight gain (ml/5% of weight gain, partial regression coefficient = 0.020, SE = 0.006, P = 0.002). In small pediatric transplants, an adult-size kidney is acceptable with reduction in k-vol. Moreover, the post-transplant k-vol might be regulated by pretransplant physique and post-transplant somatic growth.
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Affiliation(s)
- Masaki Muramatsu
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Toshihide Mizutani
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Junya Hashimoto
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Mai Kubota
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Hideyo Oguchi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Takashi Yonekura
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Kei Sakurabayashi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yujiro Aoki
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Kazunobu Shinoda
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yoshihiro Itabashi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Takeshi Kawamura
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Nobuyuki Shiraga
- Department of Radiology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Tetuo Mikami
- Department of Pathology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
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12
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Muramatsu M, Mizutani T, Hamasaki Y, Takahashi Y, Itabashi Y, Kubota M, Hashimoto J, Oguchi H, Sakurabayashi K, Hyodo Y, Shinoda K, Kawamura T, Sakai K, Shishido S. Transplantation of adult-size kidneys in small pediatric recipients: A single-center experience. Pediatr Transplant 2019; 23:e13401. [PMID: 30916370 DOI: 10.1111/petr.13401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/20/2019] [Accepted: 02/13/2019] [Indexed: 01/22/2023]
Abstract
RTx of adult-size kidneys presents a size mismatch in small pediatric recipients, and there are potential surgical complications. This study reveals the outcomes of intra- and extraperitoneal RTx in low-weight (less than 15 kg) pediatric recipients. We studied 51 pediatric patients weighing less than 15 kg who received a living-related donor renal transplant between 2009 and 2017. The intraperitoneal (group A, n = 24) and extraperitoneal (group B, n = 27) approaches were compared. In group A, the mean age, Ht, and weight were 3.8 ± 1.6 years, 83.7 ± 6.5 cm, 10.5 ± 1.8 kg; in group B, 5.0 ± 1.9 years, 95.3 ± 7.3 cm, and 13.0 ± 1.4 kg. Single renal artery grafts (21 in group A and 16 in group B) and double renal artery grafts (three in group A and 11 in group B) were performed. Of the patients with double renal artery transplants, one in group A and six in group B underwent ex vivo arterial reconstruction. The eGFR (mL/min/1.73 m2 ) at 1-week post-transplant in group A was significantly higher than that in group B; the eGFRs at 4 weeks post-transplant did not differ. One graft was lost in group B because of vascular thrombosis. Post-transplant complications included ileus and transplant ureteral stenosis. There was no significant difference in 5-year graft survival rate (group A 100%, group B 91.7%). Both transplant approaches are feasible to adapt to a size mismatch between the adult-size donor kidney and low-weight pediatric recipients.
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Affiliation(s)
- Masaki Muramatsu
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Toshihide Mizutani
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yoshihiro Itabashi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Mai Kubota
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Junya Hashimoto
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hideyo Oguchi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kei Sakurabayashi
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yoji Hyodo
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kazunobu Shinoda
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Takeshi Kawamura
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan
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13
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Abstract
BACKGROUND Infants with a body weight of less than 10 kg are often not considered to be suitable candidates for renal transplantation (RTx). The objective of this study was to evaluate this arbitrary weight threshold for pediatric RTx. METHODS We conducted a multicenter, retrospective, match-controlled cohort study on infants weighing less than 10 kg at time of engrafting (low-weight group [LWG], n = 38) compared to a matched control group (n = 76) with a body weight of 10-15 kg, using data from the first 2 years post-transplant derived from the CERTAIN Registry. RESULTS Patient survival was 97 and 100% in the LWG and control groups, respectively (P = 0.33), and death-censored graft survival was 100 and 95% in the LWG and control groups, respectively (P = 0.30). Estimated glomerular filtration rate at 2 years post-transplant was excellent and comparable between the groups (LWG 77.6 ± 34.9 mL/min/1.73 m2; control 74.8 ± 29.1 mL/min/1.73 m2; P = 0.68). The overall incidences of surgery-related complications (LWG 11%, control 23%; P = 0.12) and medical outcome measures (LWG 23%, control 36%, P = 0.17) were not significantly different between the groups. The medical outcome measures included transplant-related viral diseases (LWG 10%, control 21%; P = 0.20), acute rejection episodes (LWG 14%, control 29%; P = 0.092), malignancies (LWG 3%, control 0%; P = 0.33) and arterial hypertension (LWG 73%, control 67%; P = 0.57). CONCLUSIONS These data suggest that RTx in low-weight children is a feasible option, at least in selected centers with appropriate surgical and medical expertise.
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14
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Feygina VM, Kotru A, Du C. Abdominal distention and continuous feeding intolerance after intraperitoneal kidney transplant: Answers. Pediatr Nephrol 2018; 33:607-609. [PMID: 28589211 DOI: 10.1007/s00467-017-3708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Valeriya M Feygina
- Department of Pediatrics, Division of Pediatric Nephrology, Geisinger Medical Center, Danville, PA, 17822, USA.
| | - Anil Kotru
- Department of Transplantation and LiverSurgery, Geisinger Medical Center, Danville, PA, 17822, USA
| | - Christine Du
- Department of Transplantation and LiverSurgery, Geisinger Medical Center, Danville, PA, 17822, USA
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15
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Sugi MD, Albadawi H, Knuttinen G, Naidu SG, Mathur AK, Moss AA, Oklu R. Transplant artery thrombosis and outcomes. Cardiovasc Diagn Ther 2017; 7:S219-S227. [PMID: 29399525 DOI: 10.21037/cdt.2017.10.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Post-transplantation allograft arterial thrombosis is a well-recognized complication associated with solid organ transplantation. Much of the literature is centered on liver and kidney transplantation, which will therefore serve as the principle basis for this review, with a brief discussion on pancreas transplantation and associated arterial complications. The number of solid organ transplants has been steadily increasing over the past decade in parallel with growing demand for organs and expansion of the transplantation criteria for both donors and recipients. This increase has been accompanied by a number of innovative medical advances and surgical techniques, as well as improved imaging that has allowed for thoughtful exploration of vascular anatomic variants and the possibilities for transplant with which they are associated. It has also been accompanied by a growing field of behavioral research, as potential recipients must weigh the risk of accepting certain organs based on perceived outcomes that may differ according to the quality of the underlying organ. Improvements in imaging technology have brought greater sensitivity to detecting arterial complications in post-operative surveillance examinations and have allowed for further development of tailored endovascular and surgical interventions for transplant-associated vascular complications. This review will focus on post-transplantation solid organ allograft artery thrombosis, including discussion of risk factors, diagnostic imaging, natural history, and therapeutic options.
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Affiliation(s)
- Mark D Sugi
- Department of Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Grace Knuttinen
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Sailendra G Naidu
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Amit K Mathur
- Division of Transplant Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Adyr A Moss
- Division of Transplant Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
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16
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Tanabe T, Watanabe H, Shah JA, Sahara H, Shimizu A, Nomura S, Asfour A, Danton M, Boyd L, Meyers AD, Ekanayake-Alper DK, Sachs DH, Yamada K. Role of Intrinsic (Graft) Versus Extrinsic (Host) Factors in the Growth of Transplanted Organs Following Allogeneic and Xenogeneic Transplantation. Am J Transplant 2017; 17:1778-1790. [PMID: 28117931 PMCID: PMC5489354 DOI: 10.1111/ajt.14210] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/08/2016] [Accepted: 01/09/2017] [Indexed: 01/25/2023]
Abstract
In our studies of life-supporting α-1,3-galactocyltransferase knockout (GalT-KO) pig-to-baboon kidneys, we found that some recipients developed increased serum creatinine with growth of the grafts, without histological or immunological evidence of rejection. We hypothesized that the rapid growth of orthotopic pig grafts in smaller baboon recipients may have led to deterioration of organ function. To test this hypothesis for both kidneys and lungs, we assessed whether the growth of outbred (Yorkshire) organ transplants in miniature swine was regulated by intrinsic (graft) or extrinsic (host environment) factors. Yorkshire kidneys exhibited persistent growth in miniature swine, reaching 3.7 times their initial volume over 3 mo versus 1.2 times for miniature swine kidneys over the same time period. Similar rapid early growth of lung allografts was observed and, in this case, led to organ dysfunction. For xenograft kidneys, a review of our results suggests that there is a threshold for kidney graft volume of 25 cm3 /kg of recipient body weight at which cortical ischemia is induced in transplanted GalT-KO kidneys in baboons. These results suggest that intrinsic factors are responsible, at least in part, for growth of donor organs and that this property should be taken into consideration for growth-curve-mismatched transplants, especially for life-supporting organs transplanted into a limited recipient space.
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Affiliation(s)
- Tatsu Tanabe
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Hironosuke Watanabe
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Jigesh A Shah
- Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Hisashi Sahara
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Division of Organ Replacement and Xenotransplantation Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima University, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shunichiro Nomura
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Arsenoi Asfour
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Makenzie Danton
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Lennan Boyd
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Adrienne Dardenne Meyers
- Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, New York
| | | | - David H Sachs
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA,Corresponding author: Kazuhiko Yamada, M.D, PhD., Columbia Center for Translational Immunology, 630 W 168th St, BB1705, New York, NY, USA, Tel: +1-212-304-5695,
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17
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Abstract
Renal allograft compartment syndrome (RACS) is graft dysfunction secondary to intracompartment hypertension. The purpose of this study was to identify risk factors for RACS. We reviewed 7 cases of established RACS and all intra-abdominal placements of the kidney in order to include potential RACS. We also studied early graft losses in order to rule out a missed RACS. We compared the allograft length and width, recipient height, weight, body mass index, aberrant vessels, site of incision, and side of kidney with the remainder of the cohort as potential predictors of RACS. Among 538 transplants, 40 met the criteria for actual RACS or potential RACS. We uncovered 7 cases of RACS. Only kidney length and width were statistically significant (P = 0.041 and 0.004, respectively). The width was associated with a higher odds ratio than was length (2.315 versus 1.61). Increased allograft length and width should be considered as a potential risk for RACS.
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18
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Renal Allograft Compartment Syndrome: Is It Possible to Prevent? Transplant Proc 2016; 48:340-3. [DOI: 10.1016/j.transproceed.2015.12.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/30/2015] [Indexed: 10/21/2022]
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19
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Fontana I, Bertocchi M, Centanaro M, Varotti G, Santori G, Mondello R, Tagliamacco A, Cupo P, Barabani C, Palombo D. Abdominal compartment syndrome: an underrated complication in pediatric kidney transplantation. Transplant Proc 2015; 46:2251-3. [PMID: 25242763 DOI: 10.1016/j.transproceed.2014.07.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transplantation of a large kidney in small children can lead to many complications, including an underrated complication known as abdominal compartment syndrome (ACS), which is defined as intra-abdominal pressure (IAP)≥20 mm Hg with dysfunction of at least one thoracoabdominal organ. Presenting signs of ACS include firm tense abdomen, increased peak inspiratory pressures, oliguria, and hypotension. Between June 1, 1985, and September 30, 2013, our center performed 420 kidney transplants (deceased/living related donors: 381/39) in 314 pediatric recipients (female/male: 147/167). ACS occurred in 9 pediatric patients (weight<15 kg) who received a large kidney from adult donors. In 1 case, the patient underwent abdominal decompression with re-exploration and closure with mesh in the immediate postoperative period. In a second case, the patient developed a significant respiratory compromise with hemodynamic instability necessitating catecholamines, sedation, and assisted ventilation. For small children transplanted with a large kidney, an early diagnosis of ACS represents a critical step. From 2005 we have measured IAP during transplantation via urinary bladder pressure, and immediately after wound closure we use intraoperative and postoperative duplex sonography to value flow dynamics changes. We recommend that bladder pressure should be routinely checked in small pediatric kidney recipients who are transplanted with a large graft.
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Affiliation(s)
- I Fontana
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
| | - M Bertocchi
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - M Centanaro
- Anesthesiology and Intensive Care Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - G Varotti
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - G Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - R Mondello
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - A Tagliamacco
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - P Cupo
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - C Barabani
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - D Palombo
- Department of Surgery, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
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20
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Wood L, Yang W, Annamalai A. Mesh Hood Fascial Closure Is a Safe Alternative to Prevent Renal Allograft Compartment Syndrome During Kidney Transplantation. Transplant Proc 2015; 47:1845-9. [DOI: 10.1016/j.transproceed.2015.04.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/15/2015] [Indexed: 12/22/2022]
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21
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Copelan A, George D, Kapoor B, Nghiem HV, Lorenz JM, Erly B, Wang W. Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol 2015; 32:133-55. [PMID: 26038621 DOI: 10.1055/s-0035-1549842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As advances in surgical techniques and postoperative care continue to improve outcomes, the use of solid organ transplants as a treatment for end-stage organ disease is increasing. With the growing population of transplant patients, there is an increasing need for radiologic diagnosis and minimally invasive procedures for the management of posttransplant complications. Typical complications may be vascular or nonvascular. Vascular complications include arterial stenosis, graft thrombosis, and development of fistulae. Common nonvascular complications consist of leaks, abscess formation, and stricture development. The use of interventional radiology in the management of these problems has led to better graft survival and lower patient morbidity and mortality. An understanding of surgical techniques, postoperative anatomy, radiologic findings, and management options for complications is critical for proficient management of complex transplant cases. This article reviews these factors for kidney, liver, pancreas, islet cell, lung, and small bowel transplants.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Daniel George
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hahn Vu Nghiem
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jonathan M Lorenz
- Section of Interventional Radiology, The University of Chicago, Chicago, Illinois
| | - Brian Erly
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio ; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Weiping Wang
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Schnell D, Darmon M. Bedside Doppler ultrasound for the assessment of renal perfusion in the ICU: advantages and limitations of the available techniques. Crit Ultrasound J 2015; 7:24. [PMID: 26058500 PMCID: PMC4461647 DOI: 10.1186/s13089-015-0024-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/05/2015] [Indexed: 01/20/2023] Open
Abstract
Three Doppler-derived techniques have been proposed to assess renal perfusion at bedside: Doppler-based renal resistive index (RI) which has been extensively but imperfectly studied in assessing renal allograft status and changes in renal perfusion in critically ill patients and for predicting the reversibility of an acute kidney injury (AKI), semi-quantitative evaluation of renal perfusion using colour-Doppler which may be easier to perform and may give similar information than RI and contrast-enhanced sonography that may allow more precise renal and cortical perfusion assessment. These promising tools have several obvious advantages including their feasibility, non-invasiveness, repeatability and potential interest in assessing renal function or perfusion. However, several limits need to be taken into account with these techniques, and promising results remain associated with large areas of uncertainty. This editorial will describe more carefully advantages and limits of these techniques and will discuss their potential interest in assessing renal perfusion.
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Affiliation(s)
- David Schnell
- Medical-Surgical Intensive Care Unit, Angoulême Hospital, Angoulême, France
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23
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24
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Abstract
Ultrasonography is an excellent tool for evaluation of the renal transplant in the immediate postoperative period and for long-term follow-up. In this article, normal imaging findings and complications of renal transplantations are described. Disease processes are divided into vascular, perinephric, urologic and collecting system, and parenchymal abnormalities. Attention is paid to the time of occurrence of each complication, classic imaging findings, and potential pitfalls.
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Affiliation(s)
- Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
| | - Christopher P Sereni
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Mindy M Horrow
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
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25
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Immediate postoperative sonography of renal transplants: vascular findings and outcomes. AJR Am J Roentgenol 2013; 201:W479-86. [PMID: 23971480 DOI: 10.2214/ajr.12.10310] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and types of significant vascular findings on bedside sonography immediately after renal transplantation and which abnormalities would suggest a benefit from early surgical revision. MATERIALS AND METHODS Five hundred seventy-five renal transplant sonograms obtained within 4 hours of surgery were retrospectively reviewed for major vascular abnormalities: lack of renal artery (RA) or renal vein (RV) flow, elevated peak systolic velocity (PSV)>300 cm/s, parvus tardus waveforms, and markedly decreased or no color parenchymal flow. Clinical outcomes of abnormal cases were reviewed, including reoperations and percutaneous interventions. RESULTS Thirty-two (5.6%) patients underwent repeat surgery within the first week, 16 for nonvascular causes. Forty-seven (8.2%) patients had positive sonography findings. In 16 patients, sonography impacted the decision for reoperation, with 14 confirmed vascular diagnoses: compartment syndrome (n=7), RV thrombosis (n=3), RA thrombosis (n=1), RA and RV thromboses (n=2), and vascular steal (n=1). All were salvaged except the three RV thromboses. Two patients had no vascular abnormality at surgery. All 16 had markedly decreased color flow and varying abnormalities of PSV and waveforms. Outcomes of the remaining 31 cases were infarct (n=1), renal or iliac artery stenoses eventually requiring stents (n=4), and normalized (n=26). These 26 had elevated PSV with normal or near-normal color flow. Unpaired Student t tests showed no significant difference in PSV between patients requiring surgery or stents and those who normalized (p=0.34). CONCLUSION Immediate postoperative sonography has a spectrum of vascular findings, of which markedly decreased color flow is most likely to benefit from immediate reoperation.
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26
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Cordiner DS, Evans CA, Brundler MA, McPhillips M, Murio E, Darling M, Taheri S. A complex case of congenital cystic renal disease. BMJ Case Rep 2012; 2012:bcr.12.2011.5463. [PMID: 22605879 DOI: 10.1136/bcr.12.2011.5463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case outlines the potential complexity of autosomal recessive polycystic kidney disease (ARPKD). It highlights the challenges involved in managing this condition, some of the complications faced and areas of uncertainty in the decision making process. With a paucity of published paediatric cases on this subject, this should add to the pool of information currently available.
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Affiliation(s)
- David S Cordiner
- Department of Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK.
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27
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Heer MK, Trevillian PR, Hardy DB, Hibberd AD. Salvaging kidneys with renal allograft compartment syndrome. Transpl Int 2012; 25:e47-9. [PMID: 22309228 DOI: 10.1111/j.1432-2277.2012.01442.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Renal allograft compartment syndrome is an under recognized cause of early allograft dysfunction which can be reversed by early intervention. It occurs early after renal transplantation where closure of the anterior abdominal wall seems to compress the transplant in the limited retroperitoneal space. The literature about this syndrome in renal transplantation is sparse. Our report describes the diagnostic criteria and the management of two renal transplant recipients with this syndrome. Its diagnosis depends upon duplex vascular scan findings of reversed or absent diastolic flow in the renal vasculature in the absence of any perigraft collection or severe acute tubular necrosis. In our hands emergency laparotomy, decompression of the transplant and closure with interposition mesh salvaged these kidneys.
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Affiliation(s)
- Munish Kumar Heer
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, Newcastle, NSW, Australia.
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Thiyagarajan UM, Bagul A, Mohamed I, Nicholson ML. Post-biopsy renal allograft compartment syndrome: Addressing the problem, illustrated with a case report. Int J Surg Case Rep 2011; 2:188-90. [PMID: 22096723 DOI: 10.1016/j.ijscr.2011.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 06/13/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Renal allograft compartment syndrome (RACS) has recently been coined to describe early allograft dysfunction secondary to raised pressure in the retroperitoneal space. This may be caused by direct compression of the renal vessels or by a diffuse renal parenchymal compression. Herein, we report a renal allograft compartment syndrome secondary to a needle core transplant biopsy and discuss the management strategies in line with an updated literature review. PRESENTATION OF CASE A retrospective case-note review was carried out where a 45-year-old male had a transplant renal biopsy at 4-weeks after transplant for raising creatinine. Following biopsy patient developed abdominal discomfort and had haematuria. DISCUSSION Doppler ultrasound scanning of graft demonstrated good perfusion but a small haematoma (2 × 2 × 2 cm) in the upper pole of the kidney at the site of the biopsy. Patient was thereafter assessed conservatively with serial ultrasound monitoring. After 24 h, significant deterioration of graft function was observed. The third scan, demonstrated reversed flow in diastole in the upper pole of the kidney with a resistive index of 1.0 in the main renal vessel. With the above findings the kidney transplant was explored immediately and the transplant released from a 300 ml of liquefied haematoma, which was under considerable pressure. In the next 24-h, the patient showed an immediate return of graft function. CONCLUSION We recommend sequential ultrasound Doppler scanning as an invaluable tool to help identify early RACS. The surgical exploration and adequate heamostasis with surgical glue should be sought out in all RACS.
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Affiliation(s)
- U Mathuram Thiyagarajan
- Department of Infection, Immunity & Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Decoster T, Vermassen FEG, Peeters PC, Hoste EAJ, De Waele JJ. Abdominal decompression for intra-abdominal hypertension after simultaneous pancreas-kidney transplantation. Clin Transplant 2009; 24:118-21. [PMID: 19919612 DOI: 10.1111/j.1399-0012.2009.01147.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intra-abdominal hypertension (IAH) is increasingly recognized in critically ill patients and can result in respiratory, hemodynamic or renal dysfunction. We report the case of a patient suffering from diabetic nephropathy who underwent simultaneous pancreas-kidney transplantation. Within 12 h after the operation, the patient developed IAH resulting in oliguria and a rise in serum creatinine. Surgical abdominal decompression was performed, resulting in immediate restoration of kidney graft function.
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Affiliation(s)
- T Decoster
- Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan, Ghent, Belgium
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Fontana I, Bertocchi M, Centanaro M, Diviacco P, De Negri A, Ghinolfi D, Tommasi G, Magoni Rossi A, Santori G, Dallatomasina S, Nardi I, Piaggio F, Moraglia E, Valente U. Renal transplant compartment syndrome: a case report. Transplant Proc 2008; 40:2065-6. [PMID: 18675131 DOI: 10.1016/j.transproceed.2008.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An unusual case of early double kidney transplant dysfunction due to abdominal compartment syndrome is herein reported. A 62-year-old woman on peritoneal dialysis underwent dual kidney transplantation. The grafts were positioned extraperitoneally in both iliac possae using standard techniques. Surgical procedures and immediate postoperative period were uneventful. The urine output was immediate and the creatinine decreased, but in a few days she developed severe ascites with reduced urine output, increased creatinine, and progressive changes on Doppler ultrasound. The patient underwent paracentesis: the kidney function recovered as well as the Doppler ultrasound. Kidney biopsy was negative for rejection or renal pathology. Graft dysfunction was related to the presence of ascites. A catheter inserted in the abdomen measured intra-abdominal pressure (IAP) of 14 mm Hg. IAP correlated with renal function showing that IAP probably explained renal flow modifications.
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Affiliation(s)
- I Fontana
- Department of Transplantation, San Martino University Hospital, Genoa, Italy.
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Chung J, Caumartin Y, Warren J, Luke PPW. Acute Page kidney following renal allograft biopsy: a complication requiring early recognition and treatment. Am J Transplant 2008; 8:1323-8. [PMID: 18444936 DOI: 10.1111/j.1600-6143.2008.02215.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.
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Affiliation(s)
- J Chung
- Department of Surgery, Division of Urology, University of Western Ontario, Canada
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De Waele JJ, De Laet I. Intra-abdominal hypertension and the effect on renal function. Acta Clin Belg 2008; 62 Suppl 2:371-4. [PMID: 18284002 DOI: 10.1179/acb.2007.083] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized in critically-ill patients. They are independently associated with mortality and organ dysfunction. The kidney is especially vulnerable to the effect of increased intra-abdominal pressure (IAP) due to its anatomical position and blood supply. Several animal and human studies have provided insights into the mechanism of renal dysfunction in IAH. It is now also accepted that the adverse effects of elevated IAP on renal function can occur at lower levels of IAP, long before development of overt ACS. The mechanism of renal impairment in ACS is not yet completely understood, but there is evidence available that renal blood flow and/or altered hormone levels are involved.
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Affiliation(s)
- J J De Waele
- Intensive Care Unit, Ghent University Hospital, Gent, Belgium.
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Losanoff JE, Reichman TW, Garfinkel MR, Testa G, Millis JM. Component separation to salvage a renal allograft. Transplantation 2007; 83:366-7. [PMID: 17297419 DOI: 10.1097/01.tp.0000248765.78647.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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